Crossed Screws versus Dorsomedial Locking Plate with Compression Screw for First Metatarsocuneiform Arthrodesis: A Cadaver Study

Gruber, F.; Sinkov, Vladimir; Bae, Su-Young; Parks, Brent G.; Schon, Lew C.

doi:10.3113/fai.2008.0927

Cited by 45 publications

(62 citation statements)

References 8 publications

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“…The plantar gapping results demonstrated the unique superelastic properties of the staples with a complete recovery and restoration of the joint footprint following unloading in each test. Moreover, the plantar gapping in all of the two staple bending tests was <3 mm, which has been used as a failure criterion in previous in vitro biomechanical studies ( 21 – 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…The optimal reconstruction technique for the Lapidus arthrodesis remains controversial. Paramount to the success of any surgical approach is the ability to stabilize bony fragments, resist and recover plantar gapping and provide adequate compression across the fusion site ( 10 , 21 , 22 ). As a result, a large number of fixation techniques and devices have been utilized in order to obtain an ideal construct that could maximize rigidity, avoid excessive micromotion, and consequently reduce failure rates.…”

Section: Discussionmentioning

confidence: 99%

“…While a number of other studies have evaluated the biomechanical properties of different fixation methods for the Lapidus arthrodesis ( 3 , 5 , 9 , 17 , 18 , 21 – 28 ), variations in models and testing methods make meaningful comparison difficult. When comparing the rigidity of crossed-screw constructs with locking plates in a cadaveric study, Gruber et al ( 21 ) reported peak loads in four-point bending of 110.8 and 120.4 N, respectively. There was no mention of the gage span used in their study making comparison of the moments impossible.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Nitinol Staples for the Lapidus Arthrodesis in a Reproducible Biomechanical Model

et al. 2015

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While the Lapidus procedure is a widely accepted technique for treatment of hallux valgus, the optimal fixation method to maintain joint stability remains controversial. The purpose of this study is to evaluate the biomechanical properties of new shape memory alloy (SMA) staples arranged in different configurations in a repeatable first tarsometatarsal arthrodesis model. Ten sawbones models of the whole foot (n = 5 per group) were reconstructed using a single dorsal staple or two staples in a delta configuration. Each construct was mechanically tested non-destructively in dorsal four-point bending, medial four-point bending, dorsal three-point bending, and plantar cantilever bending with the staples activated at 37°C. The peak load (newton), stiffness (newton per millimeter), and plantar gapping (millimeter) were determined for each test. Pressure sensors were used to measure the contact force and area of the joint footprint in each group. There was a statistically significant increase in peak load in the two staple constructs compared to the single staple constructs for all testing modalities with P values range from 0.016 to 0.000. Stiffness also increased significantly in all tests except dorsal four-point bending. Pressure sensor readings showed a significantly higher contact force at time zero (P = 0.037) and contact area following loading in the two staple constructs (P = 0.045). Both groups completely recovered any plantar gapping following unloading and restored their initial contact footprint. The biomechanical integrity and repeatability of the models was demonstrated with no construct failures due to hardware or model breakdown. SMA staples provide fixation with the ability to dynamically apply and maintain compression across a simulated arthrodesis following a range of loading conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of Nitinol Staples for the Lapidus Arthrodesis in a Reproducible Biomechanical Model

et al. 2015

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“…In previous studies, construct failure was defined as displacement of 3 mm or more in any of the medial column joints [ 4 , 13 – 15 ]. The numbers of cycles until fulfilment of this failure criterion for the dorsal aspect of each joint were calculated, resulting in the following three outcomes: cycles to 3 mm displacement at talo-navicular, cycles to 3 mm displacement at naviculo-cuneiform I and cycles to 3 mm displacement at cuneiform-metatarsal I joints.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical investigation of two plating systems for medial column fusion in foot

et al. 2017

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BackgroundArthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems.MethodsEight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05.ResultsDisplacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171).ConclusionFrom biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating systems with regard to stiffness and cycles to failure. Both tested techniques for dorsomedial and plantar plating appear to be applicable for arthrodesis of the medial column of the foot and other considerations, such as access morbidity, associated deformities or surgeon's preference, may also guide the choice of plating pattern. Further clinical studies are necessary before definitive recommendations can be given.

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“…[1][2][3] However, the standard treatment for conditions such as midfoot trauma, degenerative arthritis, and large hallux valgus deformity with hypermobility of the first ray is arthrodesis of the first TMT joint. 2,[4][5][6][7][8][9] Fixation methods for this procedure are varied. 2,[8][9][10][11][12][13][14][15] The use of locking plates is one option that being increasingly used as it has been shown to be biomechanically advantageous in comparison to crossed screw fixation.…”

mentioning

confidence: 99%

Plate Alone Versus Plate and Lag Screw for Lapidus Arthrodesis: A Biomechanical Comparison of Compression

Garas

DiSegna

Patel

2018

Foot & Ankle Specialist

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Crossed Screws versus Dorsomedial Locking Plate with Compression Screw for First Metatarsocuneiform Arthrodesis: A Cadaver Study

Abstract: Further investigation of a dorsomedial plate with adjunct screw compression may be warranted for first MTC arthrodesis.

Cited by 45 publications

References 8 publications

Evaluation of Nitinol Staples for the Lapidus Arthrodesis in a Reproducible Biomechanical Model

Evaluation of Nitinol Staples for the Lapidus Arthrodesis in a Reproducible Biomechanical Model

Biomechanical investigation of two plating systems for medial column fusion in foot

Plate Alone Versus Plate and Lag Screw for Lapidus Arthrodesis: A Biomechanical Comparison of Compression

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