Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 8 , ISSUE 4 ( October-December, 2021 ) > List of Articles

ORIGINAL RESEARCH

Mechanical Analysis of Five Methods of Tibiotalar Arthrodesis Using Screw Fixation Technique: A Cadaveric Study

YeokPin Chua, WengKong Low, Rukmanikanthan Shanmugam, Aik Saw, Mark C Blackney

Keywords : Ankle arthrodesis, Anterior plate, AO screw, Arthroscopic ankle fusion, Headless screw

Citation Information : Chua Y, Low W, Shanmugam R, Saw A, Blackney MC. Mechanical Analysis of Five Methods of Tibiotalar Arthrodesis Using Screw Fixation Technique: A Cadaveric Study. J Foot Ankle Surg Asia-Pacific 2021; 8 (4):201-205.

DOI: 10.5005/jp-journals-10040-1179

License: CC BY-NC 4.0

Published Online: 20-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Many different techniques for ankle arthrodesis have been described. Compression screws require the least dissection and can be done percutaneously, hence leading to faster healing. It was conventionally carried out by using half-threaded cancellous AO screws to achieve the compressive effect across the arthrodesis site. Even with the introduction of newer implants and screw systems, there is a lack of standardization in the surgical technique used in ankle arthrodesis surgery; and there is no recent study comparing the mechanical strength of these newer implants. Hence, we performed the study to determine the biomechanical properties of the five surgical techniques for ankle fusion as mentioned above. Materials and methods: Fifteen fresh frozen cadaveric ankles were obtained and the specimens were then divided into five groups: three samples for each group; group I (two cross standard AO screw technique), group II (two cross headless compression screw technique), group III (two cross headless compression screws with anterior locking plate), group IV (three cross headless compression screws), and group V (IO Fix System). Arthrodesis fixation was then performed according to the groups divided. Each of the specimens was then tested following a standard loading protocol for its stiffness in plantar flexion, dorsiflexion, inversion, and eversion using Instron machine in NOCERAL PPUM. Results collected were analyzed using SPSS Ver 22. Results: The results showed that group II has higher stiffness in all aspects when compared with group I. We also found that group III is the stiffest construct in the aspect of plantar flexion and dorsiflexion, and it is statistically significant when comparing plantar flexion stiffness with the group I (p = 0.042) and group II (p = 0.039). On the other hand, group IV is the stiffest construct inversion and eversion comparing to other groups. Group I is the weakest construct in all-loading aspects. Conclusion: From the results of our study, we concluded that the newer generation of screws does have a biomechanical advantage over the conventional standard half-threaded AO screws. We recommend the use of headless compression screws in replacement of the standard AO half-threaded cancellous screws, and to use two cross screws with an anterior plate for open technique, or three screws fixation technique for arthroscopic ankle fusion.


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  1. Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 2005;25:44–46.
  2. Di Stefano JG, Stephen Pinney M. Ankle arthritis: etiology and epidemiology. Seminars Arthrop 2010;21(4):218–222.
  3. Bethany Gallagher M, Treatment for End-Stage Ankle Arthritis Re-evaluated.
  4. DeHeer PA, Catoire SM, Taulman J, et al. Ankle arthrodesis: a literature review. Clin Podiatr Med Surg 2012;29(4):509–527. DOI: 10.1016/j.cpm.2012.07.001.
  5. Mueckley TM, Eichorn S, von Oldenburg G, et al. Biomechanical evaluation of primary stiffness of tibiotalar arthrodesis with an intramedullary compression nail and four other fixation devices. Foot Ankle Int 2006;27(10):814–820. DOI: 10.1177/107110070602701011.
  6. Danielle Chicano EA. Podiatry today:. A closer look at a versatile internal fixation device 2012;25(9):14–20.
  7. Odutola AA, Sheridan BD, Kelly AJ. Headless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesis. Foot Ankle Surg 2012;18(2):111–113. DOI: 10.1016/j.fas.2011.03.013.
  8. Rowan R, Davey KJ. Ankle arthrodesis using an anterior AO T plate. J Bone Joint Surg Br 1999;81(1):113–116. DOI: 10.1302/0301-620x.81b1.8999.
  9. Dohm M, Purdy BA, Benjamin J. Primary union of ankle arthrodesis: review of a single institution/multiple surgeon experience. Foot Ankle Int 1994;15(6):293–296. DOI: 10.1177/107110079401500602.
  10. Nihal A, Gellman RE, Embil JM, et al. Ankle arthrodesis. Foot Ankle Surg 2008;14(1):1–10. DOI: 10.1016/j.fas.2007.08.004.
  11. Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res 2010;468(4):958–968. DOI: 10.1007/s11999-009-1074-5.
  12. Tarkin IS, Mormino MA, Clare MP, et al. Anterior plate supplementation increases ankle arthrodesis construct rigidity. Foot Ankle Int 2007;28(2):219–223. DOI: 10.3113/fai.2007.0219.
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