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Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques

The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was...

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Autores principales: Jordan, Martin C., Hufnagel, Lukas, McDonogh, Miriam, Paul, Mila M., Schmalzl, Jonas, Kupczyk, Eva, Jansen, Hendrik, Heilig, Philipp, Meffert, Rainer H., Hoelscher-Doht, Stefanie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386452/
https://www.ncbi.nlm.nih.gov/pubmed/35992345
http://dx.doi.org/10.3389/fbioe.2022.896790
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author Jordan, Martin C.
Hufnagel, Lukas
McDonogh, Miriam
Paul, Mila M.
Schmalzl, Jonas
Kupczyk, Eva
Jansen, Hendrik
Heilig, Philipp
Meffert, Rainer H.
Hoelscher-Doht, Stefanie
author_facet Jordan, Martin C.
Hufnagel, Lukas
McDonogh, Miriam
Paul, Mila M.
Schmalzl, Jonas
Kupczyk, Eva
Jansen, Hendrik
Heilig, Philipp
Meffert, Rainer H.
Hoelscher-Doht, Stefanie
author_sort Jordan, Martin C.
collection PubMed
description The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) 6.5-mm partial threaded cannulated screws, B) 4.0-mm partial threaded cannulated screws, C) 5.0-mm headless cannulated compression screws, D) 2.3-mm locking plate, and E) 2.8-mm locking plate. Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. The 2.3- and 2.8-mm plating groups showed a high drop-out rate at 100 N tension force and failed under higher tension levels of 200 N. The fracture fixation using 4.0-mm partial threaded screws showed a significantly higher repair strength and was able to withhold cyclic loading up to 300 N. The lowest peak-to-peak displacement and the highest load-to-failure and stiffness were provided by fracture fixation using 6.5-mm partial threaded cannulated screws or 5.0-mm headless cannulated compression screws. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Finally, clinical cases about the surgical application and recovery are included.
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spelling pubmed-93864522022-08-19 Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques Jordan, Martin C. Hufnagel, Lukas McDonogh, Miriam Paul, Mila M. Schmalzl, Jonas Kupczyk, Eva Jansen, Hendrik Heilig, Philipp Meffert, Rainer H. Hoelscher-Doht, Stefanie Front Bioeng Biotechnol Bioengineering and Biotechnology The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Treatment usually requires osteosynthesis. However, lack of biomechanical understanding of the ideal fixation technique persists. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) 6.5-mm partial threaded cannulated screws, B) 4.0-mm partial threaded cannulated screws, C) 5.0-mm headless cannulated compression screws, D) 2.3-mm locking plate, and E) 2.8-mm locking plate. Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. The 2.3- and 2.8-mm plating groups showed a high drop-out rate at 100 N tension force and failed under higher tension levels of 200 N. The fracture fixation using 4.0-mm partial threaded screws showed a significantly higher repair strength and was able to withhold cyclic loading up to 300 N. The lowest peak-to-peak displacement and the highest load-to-failure and stiffness were provided by fracture fixation using 6.5-mm partial threaded cannulated screws or 5.0-mm headless cannulated compression screws. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Finally, clinical cases about the surgical application and recovery are included. Frontiers Media S.A. 2022-08-04 /pmc/articles/PMC9386452/ /pubmed/35992345 http://dx.doi.org/10.3389/fbioe.2022.896790 Text en Copyright © 2022 Jordan, Hufnagel, McDonogh, Paul, Schmalzl, Kupczyk, Jansen, Heilig, Meffert and Hoelscher-Doht. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Bioengineering and Biotechnology
Jordan, Martin C.
Hufnagel, Lukas
McDonogh, Miriam
Paul, Mila M.
Schmalzl, Jonas
Kupczyk, Eva
Jansen, Hendrik
Heilig, Philipp
Meffert, Rainer H.
Hoelscher-Doht, Stefanie
Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title_full Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title_fullStr Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title_full_unstemmed Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title_short Surgical Fixation of Calcaneal Beak Fractures—Biomechanical Analysis of Different Osteosynthesis Techniques
title_sort surgical fixation of calcaneal beak fractures—biomechanical analysis of different osteosynthesis techniques
topic Bioengineering and Biotechnology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386452/
https://www.ncbi.nlm.nih.gov/pubmed/35992345
http://dx.doi.org/10.3389/fbioe.2022.896790
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