Biomechanical Analysis of Screw-Augmented Intramedullary Fixation for Tibiotalocalcaneal Arthrodesis

Abstract

Background

This study compared intramedullary (IM) fixation for tibiotalocalcaneal arthrodesis with and without a tibiotalocalcaneal augmentation screw.

Methods

Each specimen in six matched pairs of fresh frozen cadavers underwent tibiotalocalcaneal arthrodesis with an IM nail. One specimen from each pair also received a tibiotalocalcaneal augmentation screw. Initial and final stiffness, load to failure, and construct deformation at failure were calculated with dorsiflexion loading. Bone mineral density of each pair was determined. Statistical analysis was done using a paired Student t-test and a Pearson correlation.

Results

Initial and final stiffness and load to failure were significantly higher for the tibiotalocalcaneal screw augmented fixation group as compared with the specimens with no additional screw (initial stiffness, 128.0 versus 78.4 N/mm, p = 0.04; final stiffness, 230.9 versus 164.7 N/mm, p = 0.04; load to failure, 875.5 versus 660.2 N, p = 0.03). There was a significant negative correlation between bone mineral density and average construct deformation in the samples without the added tibiotalocalcaneal screw (r = –0.90, p = 0.02).

Conclusions

In tibiotalocalcaneal arthrodesis with intramedullary nail fixation, a tibiotalocalcaneal augmentation screw provides more stable fixation.

Clinical relevance

Use of an augmentation screw as described in this study may lead to lower complication rates, particularly in patients with osteopenic bone.

Keywords

Arthrodesis Fusion Intramedullary Screw Tibiotalocalcaneal

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References

Alvarez

; Barbour

T.M.

; Perkins

T.D.

: Tibiocalcaneal arthrodesis for nonbraceable neuropathic ankle deformity. Foot Ankle Int. 15: 354–359, 1994.

Berend

; Glisson

R.R.

; Nunley

J.A.

: A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 18: 639–643, 1997.

Brumback

; Toal

T.R.

Jr. ; Murphy-Zane

; Novak

V.P.

; Belkoff

S.M.

: Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J. Bone Joint Surg. 81-A: 1538–1544, 1999.

Chiodo

; Acevedo

; Sammarco

: Intramedullary rod fixation compared with blade-plate-and-screw fixation for tibiotalocalcaneal arthrodesis: A biomechanical investigation. J. Bone Joint Surg. 85-A: 2425–2428, 2003.

Chou

; Mann

R.A.

; Yaszay

: Tibiotalocalcaneal arthrodesis. Foot Ankle Int. 21: 804–808, 2000.

Cooper

P.S.

: Complications of ankle and tibiotalocalcaneal arthrodesis. Clin. Orthop. 391: 33–44, 2001.

Ebraheim

; Elgafy

; Stefancin

J.J.

: Intramedullary fibular graft for tibiotalocalcaneal arthrodesis. Clin. Orthop. 385: 165–169, 2001.

Hanson

T.W.

; Cracchiolo

III : The use of a 95 degree blade plate and a posterior approach to achieve tibiotalocalcaneal arthrodesis. Foot Ankle Int. 23: 704–710, 2002.

Kile

; Donnelly

; Gehrke

; Werner

M.E.

; Johnson

K.A.

: Tibiotalocalcaneal arthrodesis with an intramedullary device. Foot Ankle Int. 15: 669–673, 1994.

10.

Mader

; Pennig

; Gausepohl

; Patsalis

: Calcaneotalotibial arthrodesis with a retrograde posterior-to-anterior locked nail as a salvage procedure for severe ankle pathology. J. Bone Joint Surg. 85-A Suppl 4: 123–128, 2003.

11.

Maenpaa

; Lehto

M.U.

; Belt

E.A.

: Why do ankle arthrodeses fail in patients with rheumatic disease? Foot Ankle Int. 22: 403–408, 2001.

12.

Mann

; Parks

; Pak

S.S.

; Miller

S.D.

: Tibiotalocalcaneal arthrodesis: a biomechanical analysis of the rotational stability of the Biomet ankle arthrodesis nail. Foot Ankle Int. 22: 731–733, 2001.

13.

Means

K.R.

Jr. ; Parks

B.G.

; Schon

L.C.

: Intramedullary nail fixation with posterior-to-anterior versus transverse distal screw placement for tibiotalocalcaneal arthrodesis: a biomechanical investigation. Foot Ankle Int. 27: 1137–1142, 2006.

14.

Mendicino

; Catanzariti

A.R.

; Saltrick

: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing. J. Foot Ankle Surg. 43: 82–86, 2004.

15.

Millett

P.J.

; O'Malley

;: Tibiotalocalcaneal fusion with a retrograde intramedullary nail: clinical and functional outcomes. Am. J. Orthop. 31: 531–536, 2002.

16.

Moore

; Prince

; Pochatko

; Smith

J.W.

; Fleming

: Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int. 16: 433–436, 1995.

17.

Myerson

; Alvarez

R.G.

; Lam

P.W.

: Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int. 21: 643–650, 2000.

18.

Papa

J.A.

; Myerson

M.S.

: Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot. J. Bone Joint Surg. 74-A: 1042–1049, 1992.

19.

Pinzur

M.S.

; Kelikian

: Charcot ankle fusion with a retrograde locked intramedullary nail. Foot Ankle Int. 18: 699–704, 1997.

20.

Quill

G.E.

Jr. : Tibiotalocalcaneal arthrodesis. Tech. Orthop. 11: 269–273, 1996.

21.

Russotti

; Johnson

K.A.

; Cass

JR.

: Tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot. J. Bone Joint Surg. 70-A: 1304–1307, 1988.

22.

Thordarson

D.B.

; Chang

: Stress fractures and tibial cortical hypertrophy after tibiotalocalcaneal arthrodesis with an intramedullary nail. Foot Ankle Int. 20: 497–500, 1999.