Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures

Vinod Panchbhavi, Santaram Vallurupalli, Randal Morris

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Internal fixation of osteoporotic ankle fractures is associated with failure of fixation. This study compared different augmentation methods biomechanically. Materials and Methods: In nine paired fresh-frozen cadaver legs, an identical supination-external rotation type II ankle fracture was created. Fractures were stabilized using an eight-hole locking plate. In four pairs, two screws were inserted across the syndesmosis for purchase in the tibial metaphysis. One leg from each pair was randomly selected for injection of calcium sulphate-calcium phosphate graft into the screw holes. Each leg was mounted to an MTS machine in a custom loading frame. Axial cyclic loading to body weight was performed to measure displacement at the fracture site, followed by rotational loading to failure simulating a supination external rotation injury. Data were analyzed using a two-way paired t -test and ANOVA. Results: The specimens used had a mean bone mineral density of 0.49 ± 0.15 (SD) g/cm2, and a mean age of 83 ± 12 years. In the biomechanical tests, there were no significant differences between augmented and non-augmented locking plates without the tibia-pro-fibula screws in axial stiffness (p = 0.10), external rotation angle at failure (p = 0.42), failure torque (p = 0.57), energy absorbed before failure (p = 0.47), and motion at the fracture site with cyclic axial loading (p = 0.15). There were no significant differences between augmented and non-augmented locking plates with the tibia-pro-fibula screws in the external rotation angle at failure (p = 0.83), failure torque (p = 0.58), and failure energy (p = 0.4). However, the overall strength of the fixation tended to increase with tibia-pro-fibula screws and augmentation. Conclusion: Internal fixation of an osteoporotic lateral malleolar fracture using a locking plate and screws provided a construct comparable in strength to that augmented with calcium sulfate-calcium phosphate graft and/or tibia-pro-fibula screws. Clinical Relevance: Strategies to augment internal fixation of osteoporotic ankle fractures may minimize risk for failure of fixation and may enable early weight bearing mobilization and return to function in elderly patients.

Original languageEnglish (US)
Pages (from-to)696-703
Number of pages8
JournalFoot and Ankle International
Volume30
Issue number7
DOIs
StatePublished - Jul 2009

Fingerprint

Ankle Fractures
Fibula
Osteoporotic Fractures
Tibia
Weight-Bearing
Supination
Calcium Sulfate
Leg
Torque
Transplants
Cadaver
Bone Density
Analysis of Variance
Body Weight
Injections
Wounds and Injuries
calcium phosphate

Keywords

  • Ankle fixation
  • Internal fixation
  • Lateral fibular plate
  • MTS machine
  • Osteoporotic ankle fractures
  • Supination external rotation injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures. / Panchbhavi, Vinod; Vallurupalli, Santaram; Morris, Randal.

In: Foot and Ankle International, Vol. 30, No. 7, 07.2009, p. 696-703.

Research output: Contribution to journalArticle

Panchbhavi, Vinod ; Vallurupalli, Santaram ; Morris, Randal. / Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures. In: Foot and Ankle International. 2009 ; Vol. 30, No. 7. pp. 696-703.
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abstract = "Background: Internal fixation of osteoporotic ankle fractures is associated with failure of fixation. This study compared different augmentation methods biomechanically. Materials and Methods: In nine paired fresh-frozen cadaver legs, an identical supination-external rotation type II ankle fracture was created. Fractures were stabilized using an eight-hole locking plate. In four pairs, two screws were inserted across the syndesmosis for purchase in the tibial metaphysis. One leg from each pair was randomly selected for injection of calcium sulphate-calcium phosphate graft into the screw holes. Each leg was mounted to an MTS machine in a custom loading frame. Axial cyclic loading to body weight was performed to measure displacement at the fracture site, followed by rotational loading to failure simulating a supination external rotation injury. Data were analyzed using a two-way paired t -test and ANOVA. Results: The specimens used had a mean bone mineral density of 0.49 ± 0.15 (SD) g/cm2, and a mean age of 83 ± 12 years. In the biomechanical tests, there were no significant differences between augmented and non-augmented locking plates without the tibia-pro-fibula screws in axial stiffness (p = 0.10), external rotation angle at failure (p = 0.42), failure torque (p = 0.57), energy absorbed before failure (p = 0.47), and motion at the fracture site with cyclic axial loading (p = 0.15). There were no significant differences between augmented and non-augmented locking plates with the tibia-pro-fibula screws in the external rotation angle at failure (p = 0.83), failure torque (p = 0.58), and failure energy (p = 0.4). However, the overall strength of the fixation tended to increase with tibia-pro-fibula screws and augmentation. Conclusion: Internal fixation of an osteoporotic lateral malleolar fracture using a locking plate and screws provided a construct comparable in strength to that augmented with calcium sulfate-calcium phosphate graft and/or tibia-pro-fibula screws. Clinical Relevance: Strategies to augment internal fixation of osteoporotic ankle fractures may minimize risk for failure of fixation and may enable early weight bearing mobilization and return to function in elderly patients.",
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N2 - Background: Internal fixation of osteoporotic ankle fractures is associated with failure of fixation. This study compared different augmentation methods biomechanically. Materials and Methods: In nine paired fresh-frozen cadaver legs, an identical supination-external rotation type II ankle fracture was created. Fractures were stabilized using an eight-hole locking plate. In four pairs, two screws were inserted across the syndesmosis for purchase in the tibial metaphysis. One leg from each pair was randomly selected for injection of calcium sulphate-calcium phosphate graft into the screw holes. Each leg was mounted to an MTS machine in a custom loading frame. Axial cyclic loading to body weight was performed to measure displacement at the fracture site, followed by rotational loading to failure simulating a supination external rotation injury. Data were analyzed using a two-way paired t -test and ANOVA. Results: The specimens used had a mean bone mineral density of 0.49 ± 0.15 (SD) g/cm2, and a mean age of 83 ± 12 years. In the biomechanical tests, there were no significant differences between augmented and non-augmented locking plates without the tibia-pro-fibula screws in axial stiffness (p = 0.10), external rotation angle at failure (p = 0.42), failure torque (p = 0.57), energy absorbed before failure (p = 0.47), and motion at the fracture site with cyclic axial loading (p = 0.15). There were no significant differences between augmented and non-augmented locking plates with the tibia-pro-fibula screws in the external rotation angle at failure (p = 0.83), failure torque (p = 0.58), and failure energy (p = 0.4). However, the overall strength of the fixation tended to increase with tibia-pro-fibula screws and augmentation. Conclusion: Internal fixation of an osteoporotic lateral malleolar fracture using a locking plate and screws provided a construct comparable in strength to that augmented with calcium sulfate-calcium phosphate graft and/or tibia-pro-fibula screws. Clinical Relevance: Strategies to augment internal fixation of osteoporotic ankle fractures may minimize risk for failure of fixation and may enable early weight bearing mobilization and return to function in elderly patients.

AB - Background: Internal fixation of osteoporotic ankle fractures is associated with failure of fixation. This study compared different augmentation methods biomechanically. Materials and Methods: In nine paired fresh-frozen cadaver legs, an identical supination-external rotation type II ankle fracture was created. Fractures were stabilized using an eight-hole locking plate. In four pairs, two screws were inserted across the syndesmosis for purchase in the tibial metaphysis. One leg from each pair was randomly selected for injection of calcium sulphate-calcium phosphate graft into the screw holes. Each leg was mounted to an MTS machine in a custom loading frame. Axial cyclic loading to body weight was performed to measure displacement at the fracture site, followed by rotational loading to failure simulating a supination external rotation injury. Data were analyzed using a two-way paired t -test and ANOVA. Results: The specimens used had a mean bone mineral density of 0.49 ± 0.15 (SD) g/cm2, and a mean age of 83 ± 12 years. In the biomechanical tests, there were no significant differences between augmented and non-augmented locking plates without the tibia-pro-fibula screws in axial stiffness (p = 0.10), external rotation angle at failure (p = 0.42), failure torque (p = 0.57), energy absorbed before failure (p = 0.47), and motion at the fracture site with cyclic axial loading (p = 0.15). There were no significant differences between augmented and non-augmented locking plates with the tibia-pro-fibula screws in the external rotation angle at failure (p = 0.83), failure torque (p = 0.58), and failure energy (p = 0.4). However, the overall strength of the fixation tended to increase with tibia-pro-fibula screws and augmentation. Conclusion: Internal fixation of an osteoporotic lateral malleolar fracture using a locking plate and screws provided a construct comparable in strength to that augmented with calcium sulfate-calcium phosphate graft and/or tibia-pro-fibula screws. Clinical Relevance: Strategies to augment internal fixation of osteoporotic ankle fractures may minimize risk for failure of fixation and may enable early weight bearing mobilization and return to function in elderly patients.

KW - Ankle fixation

KW - Internal fixation

KW - Lateral fibular plate

KW - MTS machine

KW - Osteoporotic ankle fractures

KW - Supination external rotation injury

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