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Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis. | LitMetric

AI Article Synopsis

  • The study investigates different screw configurations for fixing Fulkerson osteotomy, a procedure used for patellofemoral instability, by analyzing their biomechanical performance through finite element analysis.
  • Four configurations of two 4.5 mm screws were tested: (1) both screws perpendicular to the osteotomy plane, (2) both perpendicular to the posterior tibial cortex, (3) one screw perpendicular to the osteotomy plane and the other to the posterior cortex, and (4) the reverse of scenario three.
  • Results showed that the fourth configuration had the least displacement (0.245 mm) during loading, indicating better stability, while the first configuration experienced the highest frictional stress and pressure between components.

Article Abstract

Background: Conventionally, two 4.5 mm cortical screws inserted toward the posterior tibial cortex are usually advocated for the fixation of Fulkerson osteotomy. This finite element analysis aimed to compare the biomechanical behavior of four different screw configurations to fix the Fulkerson osteotomy.

Materials And Methods: Fulkerson osteotomy was modeled using computerized tomography (CT) data of a patient with patellofemoral instability and fixed with four different screw configurations using two 4.5 mm cortical screws in the axial plane. The configurations were as follows: (1) two screws perpendicular to the osteotomy plane, (2) two screws perpendicular to the posterior cortex of the tibia, (3) the upper screw perpendicular to the osteotomy plane, but the lower screw is perpendicular to the posterior cortex of the tibia, and (4) the reverse position of the screw configuration in the third scenario. Gap formation, sliding, displacement, frictional stress, and deformation of the components were calculated and reported.

Results: The osteotomy fragment moved superiorly after loading the models with 1654 N patellar tendon traction force. Since the proximal cut is sloped (bevel-cut osteotomy), the osteotomy fragment slid and rested on the upper tibial surface. Afterward, the upper surface of the osteotomy fragment acted as a fulcrum, and the distal part of the fragment began to separate from the tibia while the screws resisted the displacement. The resultant total displacement was 0.319 mm, 0.307 mm, 0.333 mm, and 0.245 mm from the first scenario to the fourth scenario, respectively. The minimum displacement was detected in the fourth scenario (upper screw perpendicular to the osteotomy plane and lower screw perpendicular to the posterior tibial cortex). Maximum frictional stress and maximum pressure between components on both surfaces were highest in the first scenario (both screws perpendicular to the osteotomy plane).

Conclusions: A divergent screw configuration in which the upper screw is inserted perpendicular to the osteotomy plane and the lower screw is inserted perpendicular to the posterior tibial cortex might be a better option for the fixation of Fulkerson osteotomy. Level of evidence Level V, mechanism-based reasoning.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293552PMC
http://dx.doi.org/10.1186/s10195-023-00714-6DOI Listing

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