Biomechanical Comparison of First Tarsometatarsal Arthrodesis Constructs Over Prolonged Cyclic Testing

Abstract

Background: Traditionally, a lengthy period of nonweightbearing is required following arthrodesis of the first tarsometatarsal (TMT) joint in order to provide a stable healing environment for the bones. The goal of this research was to determine the resistance to plantar gapping of 2 locked intramedullary devices and a medial plate with crossing screw, all specifically designed for hallux valgus correction, and compare them to traditional 2-crossing screw fixation under a cyclic testing protocol. We hypothesized the locked intramedullary devices and the medial plate with crossing screw would better resist plantar gapping. Methods: Forty cadaver specimens received 1 of 4 operative treatments: a locked intramedullary device with 2 points of fixation in the cuneiform, a locked intramedullary device with 1 point of fixation in the cuneiform, a medial plate with crossing screw, or 2 crossing screws. We applied dorsiflexion bending forces to the first TMT joint using a cadaveric fatigue model for 20 000 cycles. The plantar gap between the metatarsal and cuneiform was measured at the beginning and end of cyclic testing. Thirty-six specimens were included in the final data set. Results: Both locked intramedullary device groups and the medial plate with crossing screw group exhibited significantly less gap widening compared to the 2-crossing screw group (vs 3-hole intramedullary device, P ¼ .014; vs 4-hole intramedullary device, P ¼ .010; and vs medial plate with crossing screw, P ¼ .044). The intramedullary device groups were the most stable during the cyclic fatigue test, exhibiting the smallest gap widening. The medial plate with crossing screw fixation was also more stable than crossing screws in the cyclic fatigue model. Conclusions:The locked intramedullary devices and medial plate with crossing screw resisted plantar gapping better than 2 crossing screws when used for first TMT arthrodesis. Clinical Relevance: These results indicate that locked intramedullary devices and medial plates with crossing screws may promote superior bone healing and may better tolerate early weightbearing compared with 2 crossing screws.

Assessing the Biomechanical, Kinematic, and Force Distribution Properties of the Foot Following Tarsometatarsal Joint Arthrodesis: A Systematic Review

“…Crossed screw configurations have traditionally been the method of fixation for primary arthrodesis of TMT joints [17,22,23]. A total of seven studies compared a variety of constructs against crossed screws across the first three TMT joints [17][18][19]22,23,27,29].…”

“…Crossed screw configurations have traditionally been the method of fixation for primary arthrodesis of TMT joints [17,22,23]. A total of seven studies compared a variety of constructs against crossed screws across the first three TMT joints [17][18][19]22,23,27,29]. Of those seven studies, five found a significant advantage to alternative constructs compared to crossed screws, with the other two studies finding no significant difference between alternative methods and screw fixation at the first TMT joint [17][18][19]22,23,27,29].…”

“…A total of seven studies compared a variety of constructs against crossed screws across the first three TMT joints [17][18][19]22,23,27,29]. Of those seven studies, five found a significant advantage to alternative constructs compared to crossed screws, with the other two studies finding no significant difference between alternative methods and screw fixation at the first TMT joint [17][18][19]22,23,27,29]. The two constructs that demonstrated no significant difference when compared to crossed screws were a rhomboidal dorsal plate intended to provide transverse and longitudinal stability and an interosseous fiber tape device [18,23,29].…”

“…In the 14 articles analyzed, a total of 195 human cadaver and 70 synthetic bone models were used [16][17][18][19][21][22][23][24][25][26][27][28][29]. A combination of dorsal plates, plantar plates, crossed screws, intramedullary fixation devices, shape-memory staples, and locking plates with lag screws were utilized to achieve arthrodesis.…”

“…Both the IO fixation device and crossed-screw fixation required a significantly higher failure load and demonstrated significantly less plantar gapping than the dorsal plate (p = 0.01). Prieto-Diaz and colleagues continued to study intramedullary fixation, comparing two intramedullary fixation devices (three-hole and four-hole) to a medial plate with crossing screw and crossed screw fixation [22]. Both intramedullary devices and the medial plate with crossing screw exhibited significantly less plantar gapping than the crossed screw constructs following a 20,000-cycle fatigue test (p < 0.05).…”