Skip to main content
Log in

Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone. Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome.

Materials and methods

A prospective, open-label study was performed in two surgical clinics in Norway. In 37 of 42 selected patients with Weber type B ankle fractures showing clinical and radiologic signs of osteopenic bone, at least one screw was found to be stripping during open reduction and internal fixation (ORIF). All the stripped screws were augmented with the bone void filler, and tightness was assessed clinically afterwards. All patients were followed up for 2 years. Successful healing of the fracture after 3 months and absence of radiographic movement of the augmented screws were assessed relative to the plate and the bone. Safety was assessed by recording adverse events and abnormal haematology findings.

Results

All 86 augmented screws were clinically tight after augmentation. After 3 months, all fractures healed, and 1 augmented and 1 non-augmented screw appeared to be radiographically loose. After 2 and 6 months, respectively, deep wound infections occurred in 2 patients (5%), necessitating antibiotic treatment, revision surgery and implant removal. After 2 years, all patients had resumed their normal daily activities, and none of the augmented screws showed signs of loosening.

Conclusions

Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage. Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1a,b
Fig. 2

Similar content being viewed by others

References

  1. Ahl T, Dalèn N, Selvik G (1988) Mobilization after operation of ankle fractures: good results of early motion and weight bearing. Acta Orthop Scand 59:302–306

    CAS  PubMed  Google Scholar 

  2. Ahuja S, Hunt C, Evans S, Davis PR (2002) Comparison of pull out strengths of pedicle screws using Cortoss and Palcos LV. Eur Spine J 11:S43

    Google Scholar 

  3. Bahr W (1992) Comparison of torque measurements between cortical screws and emergency replacement screws in the cadaver mandible. J Oral Maxillofac Surg 50:46–49

    CAS  PubMed  Google Scholar 

  4. Bauer M, Bergström B, Hemborg A, Andegård J (1985) Malleolar fractures: nonoperative versus operative treatment: a controlled study. Clin Orthop 199:17–27

    PubMed  Google Scholar 

  5. Bauer M, Bengnér U, Johnell O, Redlund-Johnell I (1987) Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle Int 8:26–28

    CAS  Google Scholar 

  6. Beauchamp CG, Clay NR, Thexton PW (1983) Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br 65:329–332

    CAS  PubMed  Google Scholar 

  7. Belkoff SM, Mathis JM, Erbe EM, Fenton DC (2000) Biomechanical evaluation of a new bone cement for use in vertebroplasty. Spine 25:1061–1064

    Article  CAS  PubMed  Google Scholar 

  8. Dahl OE, Garvik LJ, Lyberg T (1994) Toxic effects of methylmethacrylate monomer on leukocytes and endothelial cells in vitro. Acta Orthop Scand 65:147–153

    CAS  PubMed  Google Scholar 

  9. Deramond H, Wright NT, Belkoff SM (1999) Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 25:17S-21S

    Article  CAS  PubMed  Google Scholar 

  10. Dogra AS (1999) Early mobilisation versus immobilisation of surgically treated ankle fractures: prospective randomised control trial. Injury 30:417–419

    Article  CAS  PubMed  Google Scholar 

  11. Egol KA, Dolan R, Koval KJ (2000) Functional outcome of surgery for fractures of the ankle. J Bone Joint Surg Br 82:246–249

    CAS  PubMed  Google Scholar 

  12. Enis JE, McCollough NC, Cooper JS (1974) Effects of methylmethacrylate in osteosynthesis. Clin Orthop 105:283–294

    CAS  PubMed  Google Scholar 

  13. Erbe EM, Pomrink GJ, Murphy JP (2000) A comparison of the mechanical properties of a new synthetic cortical bone void filler (Cortoss®/Orthovita) with those of polymethyl methacrylate [abstract]. Eur Spine J 9:288

    Google Scholar 

  14. Erbe EM, Clineff TD, Gualtieri G (2001) Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate. Eur Spine J 10:S147-S152

    Article  PubMed  Google Scholar 

  15. Fernandez GN (1988) Internal fixation of the oblique, osteoporotic fracture of the lateral malleolus. Injury 19:257–258

    CAS  PubMed  Google Scholar 

  16. Flynn JM, Rodriguez-del RF, Piza PA (2000) Closed ankle fractures in the diabetic patient. Foot Ankle Int 21:311–319

    CAS  PubMed  Google Scholar 

  17. Godsiff SP, Trakru S, Kefer G, Maniar RN, Flanagan JP, Tuite JD (1993) A comparative study of early motion and immediate plaster splintage after internal fixation of unstable fractures of the ankle. Injury 24:529–530

    CAS  PubMed  Google Scholar 

  18. Horowitz SM, Doty SB, Lane JM, Burstein AH (1993) Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption. J Bone Joint Surg Am 75:802–813

    CAS  PubMed  Google Scholar 

  19. Høiness P, Stromsoe K (1999) Early complications of surgically managed ankle fractures related to the AO classification. A review of 118 ankle fractures treated with open reduction and internal fixation. Arch Orthop Trauma Surg 119:276–279

    Article  PubMed  Google Scholar 

  20. Høiness P, Stromsoe K (2000) The influence of the timing of surgery on soft tissue complications and hospital stay. A review of 84 closed ankle fractures. Ann Chir Gynaecol 89:6–9

    PubMed  Google Scholar 

  21. Hviid K, Harager K, Schantz K (2000) Aftercare of malleolar fractures in Denmark. A questionnaire study. Ugeskr Laeger 162:2747–2750

    CAS  PubMed  Google Scholar 

  22. Kannus P, Parkkari J, Niemi S, Palvanen M (1996) Epidemiology of osteoporotic ankle fractures in elderly persons in Finland [brief communications]. Ann Intern Med 125:975–978

    CAS  PubMed  Google Scholar 

  23. Karlsson J, Brandsson S, Moller M (2000) Ankle fractures. In: Management of fractures in severely osteoporotic bone. Springer, Berlin Heidelberg New York, pp 309–317

  24. Kleeman BC, Takeuchi T, Gerhart TN, Hayes WC (1992) Holding power and reinforcement of cancellous screws in human bone. Clin Orthop 284:260–266

    PubMed  Google Scholar 

  25. Lindsjö U (1985) Operative treatment of ankle fracture-dislocations: a follow-up study of 306/321 consecutive cases. Clin Orthop 199:28–38

    PubMed  Google Scholar 

  26. Litchfield JC (1987) The treatment of unstable fractures of the ankle in the elderly. Injury 18:128–132

    CAS  PubMed  Google Scholar 

  27. Mermelstein LE, Chow LC, Friedman C, Crisco JJ (1996) The reinforcement of cancellous bone screws with calcium phosphate cement. J Orthop Trauma 10:15–20

    Article  CAS  PubMed  Google Scholar 

  28. Mizel MS, Temple HT, Michelson JD, Alvarez RG, Clanton TO, Frey CC, et al (1998) Thromboembolism after foot and ankle surgery: a multicenter study. Clin Orthop 348:180–185

    PubMed  Google Scholar 

  29. Moore DC, Frankenburg EP, Goulet JA, Goldstein SA (1997) Hip screw augmentation with an in situ-setting calcium phosphate cement: an in vitro biomechanical analysis. J Orthop Trauma 11:577–583

    Article  CAS  PubMed  Google Scholar 

  30. Nordsletten L, Madsen JE (2000) Determinants for consolidation or deficient fracture healing. In: Management of fractures in severely osteoporotic bone. Springer, Berlin Heidelberg New York, pp 101–110

  31. Pfeifer BA, Krag MH, Johnson C (1994) Repair of failed transpedicle screw fixation: a biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction. Spine 19:350–353

    CAS  PubMed  Google Scholar 

  32. Polly DW Jr, Orchowski JR, Ellenbogen RG (1998) Revision pedicle screws: bigger, longer shims—what is best? Spine 12:1374–1379

    Article  Google Scholar 

  33. Rüedi TP, Murphy WM (2000) AO principles of fracture management. Thieme Medical Publishers, New York

  34. Stürup J, Nimb L, Kramhoft M, Jensen JS (1994) Effects of polymerization heat and monomers from acrylic cement on canine bone. Acta Orthop Scand 65:20–23

    CAS  PubMed  Google Scholar 

  35. Szpalski M, Gunzburg R (2002) Prevention of hip lag screw cut-out in osteoporotic patients. Bull Hosp Jt Dis 60:84–88

    Google Scholar 

  36. Szpalski M, Gunzburg R, Hayez J-P, Passuti N (2000) Renforcement de la fixation de vis à hanche avec un nouveau biomatériau composite (Cortoss®) dans les fractures pertrochantériennes. Rev Chir Orthop 88:2S62

    Google Scholar 

  37. Trafton PG, Cole PE, DiGiovanni CW (1998) Malleolar fractures: Open reduction internal fixation. In: Wiss D (ed) Master techniques in orthopaedic surgery. Lippincott-Raven, Philadelphia, pp 485–504

  38. Tropp H, Norlin R (1995) Ankle performance after ankle fracture: a randomized study of early mobilization. Foot Ankle Int 16:79–83

    CAS  PubMed  Google Scholar 

  39. Wittenberg RH, Lee K-Y, Shea M, White AA, Hayes WC (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop 296:278–287

    PubMed  Google Scholar 

  40. Wuisman PI, Van Dijk M, Staal H, Van Royen BJ (2000) Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J 9:528–533

    Article  CAS  PubMed  Google Scholar 

  41. Yerby SA, Toh E, McLain RF (1998) Revision of failed pedicle screws using hydroxyapatite cement. A biomechanical analysis. Spine 23:1657–1661

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgement

We would like to thank Orthovita (Malvern, PA, USA), the manufacturer of Cortoss, for providing logistic and financial support for performing this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Per Reidar Høiness.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andreassen, G.S., Høiness, P.R., Skraamm, I. et al. Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation. Arch Orthop Trauma Surg 124, 161–165 (2004). https://doi.org/10.1007/s00402-004-0642-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-004-0642-0

Keywords

Navigation