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Biomechanical evaluation of interference screw fixation techniques for distal radioulnar ligament reconstruction: a cadaveric experimental study

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Abstract

Introduction

In the reconstruction of distal radioulnar ligaments (DRULs), interference screws can be used for antegrade or retrograde fixation of grafts to the ulna. However, the biomechanics of interference screw fixation are currently unknown. This study aimed to determine the biomechanical effects of these two fixations on the distal radioulnar joint (DRUJ) in a cadaveric model and to investigate the appropriate initial tension.

Materials and methods

A total of 30 human cadaver upper extremities were used, and the DRULs were reconstructed according to Adams’ procedure. First, eight specimens were randomly divided into two groups: antegrade and retrograde, followed by translational testing and load testing. Then, the other eight specimens were divided into the two groups above, and the contact mechanics, including forces, areas, and pressures, were measured. Finally, to investigate the appropriate initial tension, the remaining 14 specimens were fixed with interference screws under different tensions in an antegrade way, and the translational testing was repeated as before.

Results

In the neutral position, antegrade fixation exhibited less translation than retrograde fixation (7.21 ± 0.17 mm versus 10.77 ± 1.68 mm, respectively). The maximum failure load was 70.45 ± 6.20 N in antegrade fixation, while that in retrograde fixation was 35.17 ± 2.95 N (P < 0.0001). Antegrade fixation exhibited a larger increase in contact force than retrograde fixation (99.72% ± 23.88% versus 28.18% ± 10.43%) (P = 0.001). The relationship between tension and displacement was nonlinear (Y = − 1.877 ln(x) + 7.94, R2 = 0.868, P < 0.0001).

Conclusions

Compared with retrograde fixation, the antegrade fixation of interference screws may be a more reliable surgical technique, as it shows a higher failure load and stability. In addition, to avoid the risk of potential arthritis caused by anterograde fixation, we propose an equation to determine the appropriate initial tension in DRUL reconstruction.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Jiong Yu for his contributions to this study.

Funding

This study was supported by wuxi “Taihu Talent Plan” high-level medical and health talents.

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Author notes

  1. Fengming Gu and Xiaodong Fang have the same contribution to this manuscript and are the co-first author of this paper.

Authors and Affiliations

  1. Medical College, Soochow University, Suzhou, China

    Fengming Gu & Xiaodong Fang

  2. Department of Hand Surgery, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Gang Zhao

  3. Orthopaedic Institute, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Xiaoyun Pan

  4. Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Liangxi Road No. 999, Wuxi, Jiangsu, China

    Fei Xiong, Qiuwen Ying & Jingyi Mi

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Contributions

All the authors (FMG, XDF, GZ, XYP, FX, QWY, and JYM) contributed to the study conception and design. Material preparation, data collection and analysis were performed by FMG, XDF, GZ, XYP, FX, and QWY. The first draft of the manuscript was written by FMG and critically revised by JYM. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jingyi Mi.

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The authors have no conflicts of interest to declare.

Ethical approval

The study was approved by the Ethics Committee of Wuxi 9th People’s Hospital Affiliated to Soochow University.

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Gu, F., Fang, X., Zhao, G. et al. Biomechanical evaluation of interference screw fixation techniques for distal radioulnar ligament reconstruction: a cadaveric experimental study. Arch Orthop Trauma Surg 142, 2111–2120 (2022). https://doi.org/10.1007/s00402-022-04432-2

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