• 1.

    Prissel MA, Simpson GA & Sutphen SA et al.: Ankle arthrodesis: a retrospective analysis comparing single column, locked anterior plating to crossed lag screw technique. J Foot Ankle Surg 56: 453, 2017.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    DeHeer PA, Catoire SM & Taulman J et al.: Ankle arthrodesis: a literature review. Clin Podiatr Med Surg 29: 509, 2012.

  • 3.

    Endres T, Grass R & Rammelt S et al.: Ankle arthrodesis with four cancellous lag screws. Oper Orthop Traumatol 17: 345, 2005.

  • 4.

    Winson I, Robinson D & Allen P: Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 87: 343, 2005.

  • 5.

    Zwipp H, Rammelt S & Endres T et al.: High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res 468: 958, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kitaoka HB, Anderson P & Morrey B: Revision of ankle arthrodesis with external fixation for non-union. J Bone Joint Surg Am 74: 1191, 1992.

  • 7.

    Moeckel BH, Patterson BM & Inglis AE et al.: Ankle arthrodesis. A comparison of internal and external fixation. Clin Orthop Relat Res 268: 78, 1991.

  • 8.

    Hendrickx R, Kerkhoffs G & Stufkens S et al.: Ankle fusion using a 2-incision, 3-screw technique. Oper Orthop Traumatol 23: 131, 2011.

  • 9.

    Holt ES, Hansen ST & Mayo KA et al.: Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res 268: 21, 1991.

  • 10.

    Jeng CL, Baumbach SF & Campbell J et al.: Comparison of initial compression of the medial, lateral, and posterior screws in an ankle fusion construct. Foot Ankle Int 32: 71, 2011.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Ogilvie-Harris D, Fitsialos D & Hedman T: Arthrodesis of the ankle. A comparison of two versus three screw fixation in a crossed configuration. Clin Orthop Relat Res 304: 195, 1994.

    • Search Google Scholar
    • Export Citation
  • 12.

    Salduz A, Birisik F & Polat G et al.: The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study. J Orthop Surg Res 11: 146, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Thompson JD, Benjamin JB & Szivek JA: Pullout strengths of cannulated and noncannulated cancellous bone screws. Clin Orthop Relat Res 341: 241, 1997.

    • Search Google Scholar
    • Export Citation
  • 14.

    Betz MM, Benninger EE & Favre PP et al.: Primary stability and stiffness in ankle arthrodes—crossed screws versus anterior plating. Foot Ankle Surg 19: 168, 2013.

  • 15.

    Clifford C, Berg S & McCann K et al.: A biomechanical comparison of internal fixation techniques for ankle arthrodesis. J Foot Ankle Surg 54: 188, 2015.

  • 16.

    Friedman RL, Glisson RR & Nunley JA: A biomechanical comparative analysis of two techniques for tibiotalar arthrodesis. Foot Ankle Int 15: 301, 1994.

  • 17.

    Kakarala G & Rajan DT: Comparative study of ankle arthrodesis using cross screw fixation versus anterior contoured plate plus cross screw fixation. Acta Orthop Belg 72: 716, 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Nasson S, Shuff C & Palmer D et al.: Biomechanical comparison of ankle arthrodesis techniques: crossed screws vs. blade plate. Foot Ankle Int 22: 575, 2001.

  • 19.

    Bir C, Andrecovich C & DeMaio M et al.: Evaluation of bone surrogates for indirect and direct ballistic fractures. Forensic Sci Int 261: 1, 2016.

  • 20.

    Firoozbakhsh K, DeCoster T & Moneim M: Effect of cyclical loading on the holding power of surgical screws. Orthopedics 17: 607, 1994.

  • 21.

    Schildhauer TA, Ledoux WR & Chapman JR et al.: Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 17: 22, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Early SD, Hedman TP & Reynolds RA: Biomechanical analysis of compression screw fixation versus standard in situ pinning in slipped capital femoral epiphysis. J Pediatr Orthop 21: 183, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Dragoni M, Heiner AD & Costa S et al.: Biomechanical study of 16-mm threaded, 32-mm threaded, and fully threaded SCFE screw fixation. J Pediatr Orthop 32: 70, 2012.

  • 24.

    Miyanji F, Mahar A & Oka R et al.: Biomechanical comparison of fully and partially threaded screws for fixation of slipped capital femoral epiphysis. J Pediatr Orthop 28: 49, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Breyer J, Vergara P & Parra L et al.: Metacarpophalangeal and interphalangeal joint arthrodesis: a comparative study between tension band and compression screw fixation. J Hand Surg Eur Vol 40: 374, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Cekin T, Tükenmez M & Tezeren G: Comparison of three fixation methods in transverse fractures of the patella in a calf model. Acta Orthop Traumatol Turc 40: 2006, 248.

    • Search Google Scholar
    • Export Citation
  • 27.

    Ozyurekoglu T & Turker T: Results of a method of 4-corner arthrodesis using headless compression screws. J Hand Surg Am 37: 486, 2012.

  • 28.

    Somberg AM, Whiteside WK & Nilssen E et al.: Biomechanical evaluation of a second generation headless compression screw for ankle arthrodesis in a cadaver model. Foot Ankle Surg 22: 50, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Pollard JD, Deyhim A & Rigby RB et al.: Comparison of pullout strength between 3.5-mm fully threaded, bicortical screws and 4.0-mm partially threaded, cancellous screws in the fixation of medial malleolar fractures. J Foot Ankle Surg 49: 248, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

The Effects of Different Screw Combinations on the Initial Stability of Ankle Arthrodesis

A Biomechanical Study

View More View Less
Restricted access

Background

The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs.

Methods

We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed.

Results

There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation).

Conclusions

Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site.

Acibadem Hospital, Maslak, Istanbul, Turkey.

Istanbul University, İstanbul School of Medicine, Department of Orthopedics and Traumatology, Çapa, İstanbul, Turkey.

Bakirkoy Training and Research Hospital, Department of Orthopedics and Traumatology, Bakırköy, İstanbul, Turkey.

Istanbul Technical University, Department of Mechanical Engineering, Maslak, Istanbul, Turkey.

Corresponding author: Önder Kılıçoğlu, MD, PhD, Istanbul University, İstanbul School of Medicine, Çapa, Istanbul 34100, Turkey. (E-mail: onder.kilicoglu@gmail.com)