Biomechanical comparison of 5 different fixation constructs in a trapeziometacarpal joint arthrodesis model
File(s)
Accepted version
Author(s)
Type
Journal 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.
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.
Date Issued
2024-10-01
Date Acceptance
2022-12-12
Citation
The Journal of Hand Surgery, 2024, 49 (10), pp.1036.E1-1036.E9
ISSN
0363-5023
Publisher
Elsevier
Start Page
1036.E1
End Page
1036.E9
Journal / Book Title
The Journal of Hand Surgery
Volume
49
Issue
10
Copyright Statement
© 2023 by the American Society for Surgery of the Hand. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Publication Status
Published
Date Publish Online
2023-02-09