Skip to main content
Download PDF

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Science China Life Sciences volume 59, pages 958–964 (2016)Cite this article

Abstract

The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.

References

  • Abdelgaid, S.M. (2012). Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg 18, 164–179.

    Article  PubMed  Google Scholar 

  • Bulaqi, H.A., Mousavi, M.M., Safari, H., Samandari, M.M., and Geramipanah, F. (2015). Dynamic nature of abutment screw retightening: finite element study of the effect of retightening on the settling effect. J Prosthet Dent 113, 412–419.

    Article  PubMed  Google Scholar 

  • Chen, S.H., Chiang, M.C., Hung, C.H., Lin, S.C., and Chang, H.W. (2014). Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty. Knee 21, 224–231.

    Article  PubMed  Google Scholar 

  • Claes, L., Wilke, H., Augat, P., Rübenacker, S., and Margevicius, K.J. (1995). Effect of dynamization on gap healing of diaphyseal fractures under external fixation. Clin Biomech (Bristol, Avon) 10, 227–234.

    Article  Google Scholar 

  • Doblaré, M., Garcia, J., and Gómez, M. (2004). Modelling bone tissue fracture and healing: a review. Eng Frac Mech 71, 1809–1840.

    Article  Google Scholar 

  • Folk, J.W., Starr, A.J., and Early, J.S. (1999). Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 13, 369–372.

    CAS  Article  PubMed  Google Scholar 

  • Fu, X.M., Oshima, H., Araki, Y., Narita, Y., Mutsuga, M., Okada, N., Tsunekawa, T., and Usui, A. (2013). A comparative study of two types of sternal pins used for sternal closure: poly-L-lactide sternal pins versus uncalcined hydroxyapatite poly-L-lactide sternal pins. J Artif Organs 16, 458–463.

    CAS  Article  PubMed  Google Scholar 

  • Giddings, V.L., Beaupré, G.S., Whalen, R.T., and Carter, D.R. (2000). Calcaneal loading during walking and running. Med Sci Sports Exerc 32, 627–634.

    CAS  Article  PubMed  Google Scholar 

  • Guerado, E., Bertrand, M.L., and Cano, J.R. (2012). Management of calcaneal fractures: what have we learnt over the years? Injury 43, 1640–1650.

    Article  PubMed  Google Scholar 

  • Hammond, A.W., and Crist, B.D. (2013). Percutaneous treatment of highrisk patients with intra-articular calcaneus fractures: a case series. Injury 44, 1483–1485.

    Article  PubMed  Google Scholar 

  • Huang, R., Li, X., and Rong, Q. (2013). Control mechanism for the upper airway collapse in patients with obstructive sleep apnea syndrome: a finite element study. Sci China Life Sci 56, 366–372.

    Article  PubMed  Google Scholar 

  • Liang, J., Yang, Y.F., Yu, G.R., Niu, W.X., and Wang, Y.B. (2011). Deformation and stress distribution of the human foot after plantar ligaments release: a cadaveric study and finite element analysis. Sci China Life Sci 54, 267–271.

    Article  PubMed  Google Scholar 

  • Mahato, N.K., and Murthy, S.S. (2013). Metric analysis of loading magnitudes at articular and non-articular weight-bearing surfaces in human calcaneus. Foot (Edinb) 23, 2–5.

    Article  Google Scholar 

  • Moon, S.I., Jin, F., Lee, C.J., Tsutsumi, S, and Hyon, S.H. (2005). Novel carbon nanotube/poly (L-lactic acid) nanocomposites; their modulus, thermal stability, and electrical conductivity. Macromol Symp 224, 287–295.

    CAS  Article  Google Scholar 

  • Nelson, J.D., McIff, T.E., Moodie, P.G., Iverson, J.L., and Horton, G.A. (2010). Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture. Foot Ankle Int 31, 229–235.

    Article  PubMed  Google Scholar 

  • Ni, M., Weng, X.H., Mei, J., and Niu, W.X. (2015). Primary stability of absorbable screw fixation for intra-articular calcaneal fractures: a finite element analysis. J Med Biol Eng 35, 236–241.

    Article  Google Scholar 

  • Niu, W.X., Tang, T.T., Zhang, M., Jiang, C.H., and Fan, Y.B. (2014). An in-vitro and finite element study of load redistribution in the midfoot. Sci China Life Sci 57, 1191–1196.

    Article  PubMed  Google Scholar 

  • Öhman, C., Dall’Ara, E., Baleani, M., Van Sint Jan, S., and Viceronti, M. (2008). The effects of embalming using a 4% formaln solution on the compressive mechanical properties of human cortical bone. Clin Biomech (Bristol, Avon) 23, 1294–1298.

    Article  Google Scholar 

  • Rammelt, S. (2014). An update on the treatment of calcaneal fractures. J Orthop Trauma 28, 549–550.

    Article  PubMed  Google Scholar 

  • Redfern, D.J., Oliveira, M.L., Campbell, J.T., and Belkoff, S.M. (2006). A biomechanical comparison of locking and nonlocking plates for the fixation of calcaneal fractures. Foot Ankle Int 27, 196–201.

    PubMed  Google Scholar 

  • Ren, S., Xie, B., Wang, J., and Rong, Q. (2015). Biomechanics of pelvic organ prolapse. Sci China Life Sci 58, 218–220.

    Article  PubMed  Google Scholar 

  • Sanders, R., Fortin, P., DiPasquale, T., and Walling, A. (1993). Operative treatment in 120 displaced intraarticular calcaneal fractures results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 290, 87–95.

    PubMed  Google Scholar 

  • Smerek, J.P., Kadakia, A., Belkoff, S.M., Knight, T.A., Myerson, M.S., and Jeng, C.L. (2008). Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study. Foot Ankle Int 29, 931–935.

    Article  PubMed  Google Scholar 

  • Stoffel, K., Booth, G., Rohrl, S.M., and Kuster, M. (2007). A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon) 22, 100–105.

    Article  Google Scholar 

  • Tomesen, T., Biert, J., and Frölke, J. (2011). Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am 93, 920–928.

    CAS  Article  PubMed  Google Scholar 

  • Tupis, T.M., Altman, G.T., Altman, D.T., Cook, H.A., and Miller, M.C. (2012). Femoral bone strains during antegrade nailing: a comparison of two entry points with identical nails using finite element analysis. Clin Biomech (Bristol, Avon) 27, 354–359.

    Article  Google Scholar 

  • van Dijk, M., Tunc, D.V., Smit, T.H., Higham, P., Burger, E.H., and Wuisman, P.I. (2002). In vitro and in vivo degradation of bioabsorbable PLLA spinal fusion cages. J Biomed Mater Res 63, 752–759.

    Article  PubMed  Google Scholar 

  • Wang, C.L., Chang, G.L., Tseng, C.Y., Yu, W.C., and Lin, R.M. (1998). Strength of internal fixation for calcaneal fractures. Clin Biomech (Bristol, Avon) 13, 230–233.

    Article  Google Scholar 

  • Waris, E., Konttinen, Y.T., Ashammakhi, N., Suuronen, R., and Santavirta, S. (2004). Bioabsorbable fixation devices in trauma and bone surgery: current clinical standing. Expert Rev Med Devices 1, 229–240.

    Article  PubMed  Google Scholar 

  • Wong, D.W., Wang, Y., Zhang, M., and Leung, A.K. (2015). Functional restoration and risk of non-union of the first metatarsocuneiform arthrodesis for hallux valgus: a finite element approach. J Biomech 48, 3142–3148.

    Article  Google Scholar 

  • Zhang, J., Ebraheim, N., Xiao, B., and Xu, R. (2012). A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial. J Trauma Acute Care Surg 72, 106–110.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China

    Ming Ni, Jiong Mei & Wenxin Niu

  2. Pudong New Area People’s Hospital, Shanghai, 201299, China

    Ming Ni

  3. Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Duo Wai-Chi Wong & Ming Zhang

  4. Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, 201619, China

    Wenxin Niu

Authors
  1. Ming Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Duo Wai-Chi Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiong Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenxin Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenxin Niu.

Additional information

Contributed equally to this work

This article is published with open access at link.springer.com

Open Access This article is distributed under the terms of the Creative Commons Attribution License, which permits any use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ni, M., Wong, D.WC., Mei, J. et al. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. Sci. China Life Sci. 59, 958–964 (2016). https://doi.org/10.1007/s11427-016-0010-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11427-016-0010-9

Keywords

  • finite-element analysis
  • in vitro experiment
  • calcaneal fracture
  • plate fixation
  • absorbable screw
  • biomechanics