Distal tibiofibular syndesmosis fixation: A cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation

Cox, S.; Mukherjee, Debi P.; Ogden, Alan L.; Mayuex, Raymond H.; Sadasivan, Kalia K.; Albright, James A.; Pietrzak, William S.

doi:10.1053/j.jfas.2005.01.010

Cited by 58 publications

(28 citation statements)

References 37 publications

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“…Although the placement height and number of cortices and the need for routine syndesmotic screw removal are frequently subjected to debate, most surgeons routinely remove syndesmotic screws after they believe that sufficient soft tissue healing has occurred in the interosseous and syndesmotic region. It has been confirmed in several RCTs and biomechanics research studies that bioabsorbable screws can be a alternative to MSs for DTSIs (12,13,20,28). Therefore, we believed a systemic review and meta-analysis is required to evaluate the efficacy and safety between bioabsorbable screws and MSs for syndesmotic injuries.…”

Section: Discussionmentioning

confidence: 93%

“…The results of similar functional recovery in the 2 groups were consistent with the overall included studies. A biomechanical study performed by Cox (28) demonstrated that the 5.0-mm diameter bioabsorbable copolymer screw was biomechanically equivalent to the 5.0-mm diameter stainless steel screw for repair of syndesmosis disruption. The torsional stiffness values of each fixed specimen were divided by the corresponding values for the intact specimens to minimize the influence of the unoperated properties.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Xie

Cai

Deng

et al. 2015

The Journal of Foot and Ankle Surgery

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Xie

Cai

Deng

et al. 2015

The Journal of Foot and Ankle Surgery

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“…24,[26][27][28][29][30] When biodegradable implants were investigated with hydrolytic degradation, usually only the implant material or only the mechanical properties of the implant, rather than biomechanical fixation stability, were tested, and testing usually included only static loading or only limited amount of cyclic loading. [31][32][33][34][35] In some studies, the degradation was evaluated in vivo.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical in vitro evaluation of the effect of cyclic loading on the postoperative fixation stability and degradation of a biodegradable ankle plate

Väänänen

Koistinen

Nurmi

et al. 2008

Journal Orthopaedic Research

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The effect of cyclic loading on the postoperative fixation stability of a biodegradable ankle plate was tested biomechanically during 12 weeks of hydrolytic degradation. Fracture of the lateral malleolus was simulated, and the parameters of cyclic loading were chosen to represent the physiological conditions during the healing period. Additionally, the effect of cyclic loading on degradation was investigated by measuring the inherent viscosities. In Group I, the cyclic loading was conducted in four phases with gradual increases in estimated walking distance and speed during the healing period. In Group II, cyclic loading was conducted after 12 weeks. Group III was used as a control for inherent viscosity measurements. None of the specimens failed under cyclic loading. No significant differences were found between the loaded groups in any of the parameters measured. Additionally, no significant difference was found in inherent viscosities at 12 weeks. The initial fixation stability provided by the biodegradable ankle plate remains biomechanically unchanged over 12 weeks. Cyclic loading, applied either during or after 12 weeks of hydrolytic degradation, does not seem to have any clinically relevant effect on the fixation stability or the degradation properties. [17][18][19][20] However, use of biodegradable plates to treat lateral malleolar fractures of the ankle is justified as it could make secondary plate removal unnecessary, thereby saving health care resources. 4,[21][22][23] A recent cadaver study 24 showed that a biodegradable ankle plate can provide initial stability comparable to that provided by conventional metallic fixation methods. However, in contrast to metallic devices, the fixation strength of a biodegradable implant is likely to decrease over time due to hydrolytic degradation. Furthermore, physiological loading during bone healing may affect the degradation and strength retention of biodegradable implants. Therefore, our aim was to investigate if a biodegradable plate can withstand cyclic loading and maintain fracture reduction postoperatively until the lateral malleolus fracture has healed. A secondary aim was to investigate whether cyclic loading, applied either during or after a 12-week hydrolytic degradation, has any clinically relevant effect on fixation stability and degradation properties. MATERIALS AND METHODSSolid polyethylene (PE) rods (13 mm diameter) were used as surrogates for human fibulae. Test specimens were created by securing two transversely cut PE rods together with the biodegradable Inion OTPS TM eight-hole ankle plate and Inion OTPS TM 2.8 Â 12 mm screws (Inion Oy, Tampere, Finland) (Fig. 1). The rod heads were placed in contact to resemble fracture reduction. Before fixation, the plates were rejuvenated in water at 708C for 1 min to make them malleable. Thereafter, screw holes were drilled and tapped into the rods through the screw holes of the plates. Each plate was then fixed with eight screws, that is, four screws symmetrically on both sides of the fracture (...

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“…The goal of the bioabsorbable implant is to temporarily hold the tibiofibular joint in place while the syndesmosis heals, but over time hydrolyze and degrade to the point of failure after weight bearing as started to allow for normal physiologic motion of the ankle. Two cadaveric, biomechanical studies compared the load to failure and stiffness of fixation between a stainless steel screw and a polylactide bioabsorbable screw of the same size [105,106]. Both studies found no difference in syndesmotic fixation between the metal and bioabsorbable screw group.…”

Section: Surgical Implantsmentioning

confidence: 99%

Syndesmotic Injuries in Athletes

Thormeyer¹,

Leonard²,

Hutchinson³

2012

An International Perspective on Topics in Sports Medicine and Sports Injury

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Distal tibiofibular syndesmosis fixation: A cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation

Cited by 58 publications

References 37 publications

Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Absorbable Screws Versus Metallic Screws for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Biomechanical in vitro evaluation of the effect of cyclic loading on the postoperative fixation stability and degradation of a biodegradable ankle plate

Syndesmotic Injuries in Athletes

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