Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation

Syndesmosis injuries

“…There exists an extensive literature pertaining to the technical attributes of syndesmotic screw materials and configuration. Rates of fixation failure do not appear to be different when stainless steel screws are compared with titanium screws [57]. Larger, 4.5-mm screws provide greater resistance to shear stress than do 3.5-mm screws [58], but cadaver testing suggests that there is no biomechanical advantage based on screw type during pronation external rotation injury [59].…”

“…Larger, 4.5-mm screws provide greater resistance to shear stress than do 3.5-mm screws [58], but cadaver testing suggests that there is no biomechanical advantage based on screw type during pronation external rotation injury [59]. Two syndesmotic screws provide superior stability, as compared with one [45], but biomechanical stability and outcomes are no different when three-cortical is compared with four-cortical screw placement [48,57,59,60]. The position of the foot during insertion of the syndesmotic screw does not impact final ankle range-of-motion or clinical outcome [61,62].…”

Akut ve kronik sindesmoz yaralanmaları

“…Randomize kontrollü çalışmalar sonrasında biyo-emilebilir vidalarla 4,5 mm metal vidalar ve paslanmaz çelik ile titanyum vidalar arasında klinik açıdan bir fark saptanmamış-tır. [62][63][64] Transsindesmotik ve suprasindesmotik vida yerleşimleri arasında klinik ve radyolojik bir fark yoktur; ancak, bir kadavra çalışmasında, eklem hattının 1-3 cm prokismalinden uygulanan tespitin yük verme sırasında stabiliteyi sağladığı, fakat 5 cm proksimalinden uygulandığında stabiliteyi sağlamada…”

Syndesmotic Injuries in Athletes

“…Several biomechanical studies have evaluated these parameters, and for the most part no difference in strength of fixation was found. Beumer et al [98] evaluated the difference between stainless steel and titanium screws, and found no difference in strength of fixation. The same study also noted no difference between three and four cortical fixation.…”

“…As previously discussed, there is no biomechanical difference between three cortical and four cortical fixation [98]. A prospective, randomized trial comparing two tricortical screws with one quadricortical screw showed improved subjective outcomes at three months for tricortical fixation [122].…”