Screw Placement in Subtalar Arthrodesis: A Biomechanical Study

Chuckpaiwong, Bavornrit; Easley, Mark E.; Glisson, Richard R.

doi:10.3113/fai-2009-0133

Cited by 48 publications

(15 citation statements)

References 39 publications

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“…A double screw fixation displayed greater compression, torsional stiffness, and resistance to joint rotation. (23) There is also a positive correlation between bone density and compression capacity of screws. (22) The bone in the neck is harder than the soft cancellous bone of the heel, which gives better purchase to the head.…”

Section: ❚ Discussionmentioning

confidence: 99%

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis

Chaudhari

Godoy‐Santos

Rodriguez

et al. 2020

Einstein (São Paulo)

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Objective: To compare screw fixation strength for subtalar arthrodesis. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. Results: Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion: In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.

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Section: ❚ Discussionmentioning

confidence: 99%

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis

Chaudhari

Godoy‐Santos

Rodriguez

et al. 2020

Einstein (São Paulo)

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“…Chuckpaiwong et al (8) measured the contact area in the STJ with a single screw fixation and noted that the mean contact area ranged from 119 to 197 mm 2 . These values are, on average, only about 30% of the size of the entire posterior facet, which they measured at 582 AE 103 mm 2 .…”

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confidence: 99%

“…When this construct is challenged intraoperatively, and residual rotation is available at the site, the addition of a second point of fixation could be prudent in an effort to definitively secure the construct (7). When arthrodesis is performed in cases of malunion or nonunion, the use of 2 points for fixation is recommended to enhance the stability (8)(9)(10). Although it can be argued that 2 screws provide a more stable subtalar fusion construct, some surgeons might question whether 2 points of fixation are necessary, given the natural morphology of the joint.…”

mentioning

confidence: 99%

“…In 1 large, retrospective study of isolated STJ fusion, both single-screw and 2-screw techniques were used, and no statistically significant differences were noted in the union rate between the 2 groups (11). A more recent study, however, was conducted to determine the comparative effectiveness of screw fixation techniques used in STJ fusion (8). The results revealed a greater average compressive force, torsional stiffness, and joint rotation resistance achieved with double screw fixation compared with the use of a single screw (8).…”

mentioning

confidence: 99%

“…A more recent study, however, was conducted to determine the comparative effectiveness of screw fixation techniques used in STJ fusion (8). The results revealed a greater average compressive force, torsional stiffness, and joint rotation resistance achieved with double screw fixation compared with the use of a single screw (8).…”

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confidence: 99%

See 2 more Smart Citations

A Technique of Lateral Process Blockade for Subtalar Joint Fusion: An Easy, Economical, and Effective Method to Prevent Rotation

Judge

Masowick

2013

The Journal of Foot and Ankle Surgery

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Micro‐CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions

Requist

Sripanich

Rolvien

et al. 2021

Journal Orthopaedic Research

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Injuries to the Lisfranc complex may require surgical fixation, the stability of which may be correlated with bone mineral density (BMD). However, there is limited research on regional BMD variations in the Lisfranc complex. This study used quantitative micro-CT to characterize regional BMD in the four bones (medial cuneiform, intermediate cuneiform, first metatarsal, and second metatarsal) of this complex.Twenty-four cadaveric specimens were imaged with a calibration phantom using micro-CT. Each bone was segmented and divided into eight regions based on an anatomical coordinate system. BMD for each octant was calculated using scanspecific calibration equations and average image intensity. Differences between regions were analyzed using ANOVA with post hoc analysis and differences between groups of four octants in each plane were analyzed with t-tests with significance level α = 0.05. The highest density region in the medial cuneiform was the distal-dorsal-lateral and dorsal regions showed significantly higher BMD than plantar regions. The intermediate cuneiform had the highest density in the distal-dorsal-medial region and the dorsal and medial regions had higher BMD than the plantar and lateral regions, respectively. The densest region of the first metatarsal was the distal-dorsal-lateral and distal regions had significantly higher BMD than proximal regions. In the second metatarsal, the distal-dorsal-medial region had the highest density, and the distal, dorsal, and medial regions had significantly higher BMD than the proximal, plantar, and lateral regions, respectively. The predominant finding was a pattern of increased density in the dorsal bone regions, which may be relevant in the surgical management of Lisfranc injuries.

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Screw Placement in Subtalar Arthrodesis: A Biomechanical Study

Abstract: The results provide an objective basis for selection of optimal screw placement by the surgeon.

Cited by 48 publications

References 39 publications

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis

A Technique of Lateral Process Blockade for Subtalar Joint Fusion: An Easy, Economical, and Effective Method to Prevent Rotation

Micro‐CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions

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