A biomechanical comparison of conventional versus an anatomic plate and compression bolts for fixation of intra-articular calcaneal fractures

Abstract

The purpose of this study was to compare the biomechanical stability obtained by using our technique featured an anatomical plate and compression bolts versus that of the conventional anatomic plate and cancellous screws in the fixation of intraarticular calcaneal fractures. Eighteen fresh frozen lower limbs of cadavers were used to create a reproductive Sanders type-III calcaneal fracture model by using osteotomy. The calcaneus fractures were randomly selected to be fixed either using our anatomical plate and compression bolts or conventional anatomic plate and cancellous screws. Reduction of fracture was evaluated through X radiographs. Each calcaneus was successively loaded at a frequency of 1 Hz for 1000 cycles through the talus using an increasing axial force 20 N to 200 N and 20 N to 700 N, representing the partial weight bearing and full weight bearing, respectively, and then the specimens were loaded to failure. Data extracted from the mechanical testing machine were recorded and used to test for difference in the results with the Wilcoxon signed rank test. No significant difference was found between our fixation technique and conventional technique in displacement during 20–200 N cyclic loading (P=0.06), while the anatomical plate and compression bolts showed a great lower irreversible deformation during 20–700 N cyclic loading (P=0.008). The load achieved at loss of fixation of the constructs for the two groups had significant difference: anatomic plate and compression bolts at 3839.6±152.4 N and anatomic plate and cancellous screws at 3087.3±58.9 N (P=0.008). There was no significant difference between the ultimate displacements. Our technique featured anatomical plate and compression bolts for calcaneus fracture fixation was demonstrated to provide biomechanical stability as good as or better than the conventional anatomic plate and cancellous screws under the axial loading. The study supports the mechanical viability of using our plate and compression bolts for the fixation of calcaneal fracture.

Keywords

calcaneal fracture / anatomic plate fixation / compression bolts / conventional screws / biomechanical testing

References

[1] CohenM.. Calcaneal fractures. Foot Ankle Surg, 2001, 2: 1819-1863

[2] DhillonM.S., BaliK., PrabhakarS.. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg, 2011, 95(3): 171-181

[3] JarvholmU., KornerL., ThorenO., et al.. Fractures of the calcaneus. A comparison of open and closed treatment. Acta Orthop Scand, 1984, 55(6): 652-656

[4] ThordarsonD.B., KriegerL.E.. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int, 1996, 17(1): 2-9

[5] AllmacherD.H., GallesK.S., MarshJ.L.. Intra-articular calcaneal fractures treated nonoperatively and followed sequentially for 2 decades. J Orthop Trauma, 2006, 20(7): 464-469

[6] CarrJ.B., TiggesR.G., WayneJ.S., et al.. Internal fixation of experimental intraarticular calcaneal fractures: a biomechanical analysis of two fixation methods. J Orthop Trauma, 1997, 11(6): 425-429

[7] StulikJ., StehlikJ., RysavyM., et al.. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg Br, 2006, 88(12): 1634-1641

[8] TornettaP.3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res, 2000, 375: 91-96

[9] CarrJ.B.. Surgical treatment of intra-articular calcaneal fractures: a review of small incision approaches. J Orthop Trauma, 2005, 19(2): 109-117

[10] HutchinsonF.3rd, HuebnerM.K.. Treatment of os calcis fractures by open reduction and internal fixation. Foot Ankle Int, 1994, 15(5): 225-232

[11] ZwippH., TscherneH., ThermannH., et al.. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res, 1993, 290: 76-86

[12] LetournelE.. Open treatment of acute calcaneal fractures. Clin Orthop Relat Res, 1993, 290: 60-67

[13] LaughlinR.T., CarsonJ.G., CalhounJ.H.. Displaced intra-articular calcaneus fractures treated with the Galveston plate. Foot Ankle Int, 1996, 17(2): 71-78

[14] BuckleyR., ToughS., McCormackR., et al.. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am, 2002, 84-A(10): 1733-1744

[15] ZwippH., RammeltS., BarthelS.. Calcaneal fractures-open reduction and internal fixation (ORIF). Injury, 2004, 35(2): 46-54

[16] RammeltS., ZwippH.. Calcaneus fractures: facts, controversies and recent developments. Injury, 2004, 35(5): 443-461

[17] GeelC.W., FlemisterA.S.Jr.. Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma, 2001, 50(6): 1083-1089

[18] RammeltS., BarthelS., BiewenerA., et al.. Calcaneus fractures. Open reduction and internal fixation. Zentralbl Chir, 2003, 128(6): 517-528

[19] TalaricoL.M., VitoG.R., ZyryanovS.Y.. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing. J Foot Ankle Surg, 2004, 43(1): 43-50

[20] Essex-LoprestiP.. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg, 1952, 39(157): 395-419

[21] SandersR.. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am, 2000, 82(2): 225-250

[22] RammeltS., GavlikJ.M., ZwippH.. Historical and current treatment of calcaneal fractures. J Bone Joint Surg Am, 2001, 83-A(9): 1438-1440

[23] BadetR., RibeiroF., RumelhartC., et al.. Comparative biomechanical study of 3 types of osteosynthesis of the Duparc grade IV fractures of the calcaneus: value of triangular internal fixation. Rev Chir Orthop Reparatrice Appar Mot, 1999, 85(6): 601-611

[24] LinP.P., RoeS., KayM., et al.. Placement of screws in the sustentaculum tali. A calcaneal fracture model. Clin Orthop Relat Res, 1998, 352: 194-201

[25] RichterM., GoslingT., ZechS., et al.. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int, 2005, 26(4): 309-319

[26] GiddingsV.L., BeaupreG.S., WhalenR.T., et al.. Calcaneal loading during walking and running. Med Sci Sports Exerc, 2000, 3(3): 627-634

[27] RedfernD.J., OliveiraM.L., CampbellJ.T., et al.. A biomechanical comparison of locking and nonlocking plates for the fixation of calcaneal fractures. Foot Ankle Int, 2006, 27(3): 196-201

[28] WangQ., ChenW., SuY., et al.. Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts—the clinical evaluation of cohort of 156 patients. J Trauma, 2010, 69(6): 1515-1522

[29] PaulM., PeterR., HoffmeyerP.. Fractures of the calcaneum. A review of 70 patients. J Bone Joint Surg Br, 2004, 86(8): 1142-1145

[30] StoffelK., BoothG., RohrlS.M., et al.. A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech, 2007, 22(1): 100-105