The use of calcium sulfate and calcium phosphate composite graft to augment screw purchase in osteoporotic ankles

Vinod Panchbhavi, Santaram Vallurupalli, Randal Morris, Rita Patterson

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws. Materials and Methods: Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine. Results: After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger. Conclusion: Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model. Clinical relevance: Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.

Original languageEnglish (US)
Pages (from-to)593-600
Number of pages8
JournalFoot and Ankle International
Volume29
Issue number6
DOIs
StatePublished - Jun 2008

Fingerprint

Calcium Sulfate
Fibula
Ankle
Osteoporotic Fractures
Leg
Transplants
Ankle Fractures
Tibia
Cadaver
Fluoroscopy
Photon Absorptiometry
Weight-Bearing
Bone Density
calcium phosphate
Injections

Keywords

  • Ankle fracture
  • Augmentation
  • Fragility fracture
  • Osteoporotic

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The use of calcium sulfate and calcium phosphate composite graft to augment screw purchase in osteoporotic ankles. / Panchbhavi, Vinod; Vallurupalli, Santaram; Morris, Randal; Patterson, Rita.

In: Foot and Ankle International, Vol. 29, No. 6, 06.2008, p. 593-600.

Research output: Contribution to journalArticle

Panchbhavi, Vinod ; Vallurupalli, Santaram ; Morris, Randal ; Patterson, Rita. / The use of calcium sulfate and calcium phosphate composite graft to augment screw purchase in osteoporotic ankles. In: Foot and Ankle International. 2008 ; Vol. 29, No. 6. pp. 593-600.
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abstract = "Background: Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws. Materials and Methods: Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine. Results: After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger. Conclusion: Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model. Clinical relevance: Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.",
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N2 - Background: Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws. Materials and Methods: Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine. Results: After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger. Conclusion: Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model. Clinical relevance: Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.

AB - Background: Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws. Materials and Methods: Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine. Results: After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger. Conclusion: Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model. Clinical relevance: Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.

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