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First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants

Background and Objectives: The aim of this study was to investigate under dynamic loading the potential biomechanical benefit of simulated first tarsometatarsal (TMT-1) fusion with low-profile superelastic nitinol staples used as continuous compression implants (CCIs) in two different configurations...

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Autores principales: Sands, Andrew, Zderic, Ivan, Swords, Michael, Gehweiler, Dominic, Ciric, Daniel, Roth, Christoph, Nötzli, Christoph, Gueorguiev, Boyko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10383077/
https://www.ncbi.nlm.nih.gov/pubmed/37512121
http://dx.doi.org/10.3390/medicina59071310
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author Sands, Andrew
Zderic, Ivan
Swords, Michael
Gehweiler, Dominic
Ciric, Daniel
Roth, Christoph
Nötzli, Christoph
Gueorguiev, Boyko
author_facet Sands, Andrew
Zderic, Ivan
Swords, Michael
Gehweiler, Dominic
Ciric, Daniel
Roth, Christoph
Nötzli, Christoph
Gueorguiev, Boyko
author_sort Sands, Andrew
collection PubMed
description Background and Objectives: The aim of this study was to investigate under dynamic loading the potential biomechanical benefit of simulated first tarsometatarsal (TMT-1) fusion with low-profile superelastic nitinol staples used as continuous compression implants (CCIs) in two different configurations in comparison to crossed screws and locked plating in a human anatomical model. Materials and Methods: Thirty-two paired human anatomical lower legs were randomized to four groups for TMT-1 treatment via: (1) crossed-screws fixation with two 4.0 mm fully threaded lag screws; (2) plate-and-screw fixation with a 4.0 mm standard fully threaded cortex screw, inserted axially in lag fashion, and a 6-hole TMT-1 Variable-Angle (VA) Fusion Plate 2.4/2.7; (3) CCI fixation with two two-leg staples placed orthogonally to each other; (4) CCI fixation with one two-leg staple and one four-leg staple placed orthogonally to each other. Each specimen was biomechanically tested simulating forefoot weightbearing on the toes and metatarsals. The testing was performed at 35–37 °C under progressively increasing cyclic axial loading until construct failure, accompanied by motion tracking capturing movements in the joints. Results: Combined adduction and dorsiflexion movement of the TMT-1 joint in unloaded foot condition was associated with no significant differences among all pairs of groups (p ≥ 0.128). In contrast, the amplitude of this movement between unloaded and loaded foot conditions within each cycle was significantly bigger for the two CCI fixation techniques compared to both crossed-screws and plate-and-screw techniques (p ≤ 0.041). No significant differences were detected between the two CCI fixation techniques, as well as between the crossed-screws and plate-and-screw techniques (p ≥ 0.493) for this parameter of interest. Furthermore, displacements at the dorsal and plantar aspects of the TMT-1 joint in unloaded foot condition, together with their amplitudes, did not differ significantly among all pairs of groups (p ≥ 0.224). Conclusions: The low-profile superelastic nitinol staples demonstrate comparable biomechanical performance to established crossed-screws and plate-and-screw techniques applied for fusion of the first tarsometatarsal joint.
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spelling pubmed-103830772023-07-30 First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants Sands, Andrew Zderic, Ivan Swords, Michael Gehweiler, Dominic Ciric, Daniel Roth, Christoph Nötzli, Christoph Gueorguiev, Boyko Medicina (Kaunas) Article Background and Objectives: The aim of this study was to investigate under dynamic loading the potential biomechanical benefit of simulated first tarsometatarsal (TMT-1) fusion with low-profile superelastic nitinol staples used as continuous compression implants (CCIs) in two different configurations in comparison to crossed screws and locked plating in a human anatomical model. Materials and Methods: Thirty-two paired human anatomical lower legs were randomized to four groups for TMT-1 treatment via: (1) crossed-screws fixation with two 4.0 mm fully threaded lag screws; (2) plate-and-screw fixation with a 4.0 mm standard fully threaded cortex screw, inserted axially in lag fashion, and a 6-hole TMT-1 Variable-Angle (VA) Fusion Plate 2.4/2.7; (3) CCI fixation with two two-leg staples placed orthogonally to each other; (4) CCI fixation with one two-leg staple and one four-leg staple placed orthogonally to each other. Each specimen was biomechanically tested simulating forefoot weightbearing on the toes and metatarsals. The testing was performed at 35–37 °C under progressively increasing cyclic axial loading until construct failure, accompanied by motion tracking capturing movements in the joints. Results: Combined adduction and dorsiflexion movement of the TMT-1 joint in unloaded foot condition was associated with no significant differences among all pairs of groups (p ≥ 0.128). In contrast, the amplitude of this movement between unloaded and loaded foot conditions within each cycle was significantly bigger for the two CCI fixation techniques compared to both crossed-screws and plate-and-screw techniques (p ≤ 0.041). No significant differences were detected between the two CCI fixation techniques, as well as between the crossed-screws and plate-and-screw techniques (p ≥ 0.493) for this parameter of interest. Furthermore, displacements at the dorsal and plantar aspects of the TMT-1 joint in unloaded foot condition, together with their amplitudes, did not differ significantly among all pairs of groups (p ≥ 0.224). Conclusions: The low-profile superelastic nitinol staples demonstrate comparable biomechanical performance to established crossed-screws and plate-and-screw techniques applied for fusion of the first tarsometatarsal joint. MDPI 2023-07-15 /pmc/articles/PMC10383077/ /pubmed/37512121 http://dx.doi.org/10.3390/medicina59071310 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sands, Andrew
Zderic, Ivan
Swords, Michael
Gehweiler, Dominic
Ciric, Daniel
Roth, Christoph
Nötzli, Christoph
Gueorguiev, Boyko
First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title_full First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title_fullStr First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title_full_unstemmed First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title_short First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants
title_sort first tarsometatarsal joint fusion in foot—a biomechanical human anatomical specimen analysis with use of low-profile nitinol staples acting as continuous compression implants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10383077/
https://www.ncbi.nlm.nih.gov/pubmed/37512121
http://dx.doi.org/10.3390/medicina59071310
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