Cargando…

A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures

BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An...

Descripción completa

Detalles Bibliográficos
Autores principales: Switaj, Paul J., Fuchs, Daniel, Alshouli, Mohammed, Patwardhan, Avinash G., Voronov, Leonard I., Muriuki, Muturi, Havey, Robert M., Kadakia, Anish R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024498/
https://www.ncbi.nlm.nih.gov/pubmed/27628500
http://dx.doi.org/10.1186/s13018-016-0435-5
_version_ 1782453813138948096
author Switaj, Paul J.
Fuchs, Daniel
Alshouli, Mohammed
Patwardhan, Avinash G.
Voronov, Leonard I.
Muriuki, Muturi
Havey, Robert M.
Kadakia, Anish R.
author_facet Switaj, Paul J.
Fuchs, Daniel
Alshouli, Mohammed
Patwardhan, Avinash G.
Voronov, Leonard I.
Muriuki, Muturi
Havey, Robert M.
Kadakia, Anish R.
author_sort Switaj, Paul J.
collection PubMed
description BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern. This study sought to biomechanically compare an emerging technology with an established method of fixation for distal fibular fractures that traditionally require an extensive exposure. METHODS: Ten matched cadaveric pairs from the proximal tibia to the foot were prepared to simulate an Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 44C2 ankle fracture and randomized to fixation with a distal fibular locking plate or intramedullary fibular rod. A constant 700-N axial load was applied, and all specimens underwent testing for external rotation stiffness, external rotation cyclic loading, and torque to failure. The syndesmotic diastasis, stiffness, torque to failure, angle at failure, and mode of failure were obtained from each specimen. RESULTS: There was no significant difference in syndesmotic diastasis during cyclic loading or at maximal external rotation between the rod and plate groups. Post-cycle external rotation stiffness across the syndesmosis was significantly higher for the locking plate than the fibular rod. There was no significant difference between the rod and plate in torque at failure or external rotation angle. The majority of specimens had failure at the syndesmotic screw. CONCLUSIONS: In the present cadaveric study of an AO/OTA 44C2 ankle fracture, a modern fibular rod demonstrated less external rotation stiffness while maintaining the syndesmotic diastasis to within acceptable tolerances and having similar failure characteristics.
format Online
Article
Text
id pubmed-5024498
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-50244982016-09-20 A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures Switaj, Paul J. Fuchs, Daniel Alshouli, Mohammed Patwardhan, Avinash G. Voronov, Leonard I. Muriuki, Muturi Havey, Robert M. Kadakia, Anish R. J Orthop Surg Res Research Article BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern. This study sought to biomechanically compare an emerging technology with an established method of fixation for distal fibular fractures that traditionally require an extensive exposure. METHODS: Ten matched cadaveric pairs from the proximal tibia to the foot were prepared to simulate an Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 44C2 ankle fracture and randomized to fixation with a distal fibular locking plate or intramedullary fibular rod. A constant 700-N axial load was applied, and all specimens underwent testing for external rotation stiffness, external rotation cyclic loading, and torque to failure. The syndesmotic diastasis, stiffness, torque to failure, angle at failure, and mode of failure were obtained from each specimen. RESULTS: There was no significant difference in syndesmotic diastasis during cyclic loading or at maximal external rotation between the rod and plate groups. Post-cycle external rotation stiffness across the syndesmosis was significantly higher for the locking plate than the fibular rod. There was no significant difference between the rod and plate in torque at failure or external rotation angle. The majority of specimens had failure at the syndesmotic screw. CONCLUSIONS: In the present cadaveric study of an AO/OTA 44C2 ankle fracture, a modern fibular rod demonstrated less external rotation stiffness while maintaining the syndesmotic diastasis to within acceptable tolerances and having similar failure characteristics. BioMed Central 2016-09-15 /pmc/articles/PMC5024498/ /pubmed/27628500 http://dx.doi.org/10.1186/s13018-016-0435-5 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided 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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Switaj, Paul J.
Fuchs, Daniel
Alshouli, Mohammed
Patwardhan, Avinash G.
Voronov, Leonard I.
Muriuki, Muturi
Havey, Robert M.
Kadakia, Anish R.
A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title_full A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title_fullStr A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title_full_unstemmed A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title_short A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures
title_sort biomechanical comparison study of a modern fibular nail and distal fibular locking plate in ao/ota 44c2 ankle fractures
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024498/
https://www.ncbi.nlm.nih.gov/pubmed/27628500
http://dx.doi.org/10.1186/s13018-016-0435-5
work_keys_str_mv AT switajpaulj abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT fuchsdaniel abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT alshoulimohammed abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT patwardhanavinashg abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT voronovleonardi abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT muriukimuturi abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT haveyrobertm abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT kadakiaanishr abiomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT switajpaulj biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT fuchsdaniel biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT alshoulimohammed biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT patwardhanavinashg biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT voronovleonardi biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT muriukimuturi biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT haveyrobertm biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures
AT kadakiaanishr biomechanicalcomparisonstudyofamodernfibularnailanddistalfibularlockingplateinaoota44c2anklefractures