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Screw tip augmentation leads to improved primary stability in the minimally invasive treatment of displaced intra-articular fractures of the calcaneus: a biomechanical study

  • Martin Eichinger
  • Alexander Brunner
  • Hannes Stofferin
  • Andreas Bölderl
  • Michael Blauth
  • Werner Schmölz
Original Paper
  • 16 Downloads

Abstract

Purpose

To investigate if the stability of minimally invasive screw osteosynthesis of displaced intra-articular calcaneal fractures (DIACF) can be effectively increased by an innovative approach to screw tip augmentation.

Methods

In eight-paired human cadaver hindfoot specimens, DIACF of Sanders type IIB were treated with either standard screw osteosynthesis or with bone cement augmentation of the screw tips in the main fragments. The instrumented specimens were subjected to a cyclic loading protocol (9000 cycles, with stepwise increasing loads, 100–1000 N). The interfragment motions were quantified as tuber fragment tilt (TFT) and posterior facet inclination angle (PFIA) using a 3-D motion analysis system. Böhler’s angle (BA) was evaluated from X-rays. A load-to-failure test was performed after the cyclic loading protocol.

Results

All but one specimen of the augmented group withstood more cycles than the respective specimens of the non-augmented group. Mean cycles to failure for the failure criterion of 5° TFT were 7299 ± 1876 vs. 3864 ± 1810, corresponding to loads of 811 N ± 195 vs. 481 N ± 180, (P = 0.043). There were no significant differences observed in the PFIAs. The failure criterion of 5° BA was reached after a mean of 7929 cycles ± 2004 in the augmented group and 4129 cycles ± 2178 in the non-augmented group, corresponding to loads of 893 N ± 200 vs. 513 N ± 218, (P = 0,090). The mean load-to-failure of the four specimens in the augmented group that completed the cyclic loading was 1969 N over a 1742–2483 N range.

Conclusion

Screw tip augmentation significantly improved the mechanical stability of the calcanei after osteosynthesis in terms of decreased tuber fragment tilts and less changes in Böhler’s angle.

Keywords

Calcaneus fracture Screw fixation Augmentation Cement Biomechanics 

Notes

Acknowledgments

We want to thank Nora Klier for assisting with the surgical procedures and testings, Cornelia Qadri for her competent technical support and Clemens Unterwurzacher for photography and illustrations. Martin Eichinger received a research grant by DePuy Synthes, J&J Austria. Additionally, we would like to thank all body donors.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of Anatomy, Histology and Embryology, Division of Clinical and Functional AnatomyMedical University of InnsbruckInnsbruckAustria

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