AI Article Synopsis
- The study evaluates five different fixation methods for trapeziometacarpal joint arthrodesis using a porcine model to assess their biomechanical stability.
- The crossed headless compression screws (HCSs) showed the best performance, being significantly stiffer than other methods during testing and demonstrating consistent stability under load until failure.
- Both standard compression plating (CP) and locked compression plating (LCP) exhibited similar biomechanical performance, suggesting that while HCSs may offer the best option for preventing nonunion, CP and LCP are also viable alternatives.
Article Abstract
Purpose: Trapeziometacarpal joint (TMC) arthrodesis has a high rate of nonunion. This biomechanical analysis sought to determine the stiffness of 5 fixation methods in a TMC joint arthrodesis model.
Methods: Five fixation constructs were tested in a validated porcine model: crossed 1.1-mm K-wires, crossed 1.6-mm K-wires, crossed headless compression screws (HCSs), compression plating (CP), and locked compression plating (LCP). The cantilever bending stiffness was measured in abduction, adduction, flexion, and extension. Samples were loaded to failure in extension, and the mode of failure was examined.
Results: The crossed HCSs performed consistently well in all tests. Loading to failure resulted in screw pullout. In abduction and adduction, HCS and 1.6-mm K-wires were significantly stiffer than the other constructs. The mean load to failure in extension was similar in the HCS, CP, and LCP groups (304 N/mm, 311 N/mm, and 293 N/mm, respectively). There were no differences between CP and LCP in any biomechanical tests, and the mode of failure was through plate bending. The crossed 1.1-mm K-wires performed poorly in all tests.
Conclusions: Crossed HCS displayed the greatest overall stability. Standard plating in compression mode and LCP had a similar biomechanical performance.
Clinical Relevance: The ideal construct stiffness required for the successful union after TMC joint arthrodesis is unknown, but HCS has the best overall biomechanical performance and, therefore, might be considered the best choice for this clinical setting.
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| http://dx.doi.org/10.1016/j.jhsa.2022.12.010 | DOI Listing |
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