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Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis

Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis
Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis
Objective. Compare the initial stability at the fusion site of ankle arthrodesis fixed with two and three screws.
Design. Finite element models of ankle arthrodesis were developed from computed tomography images. Two-screw constructs were augmented with a third screw in different orientations and subjected to loads likely to affect the ankle postoperatively.
Background. More stable fixation seems to increase the chance of fusion, as it minimises the motion between the tibiotalar interfaces.
Methods. Non-linear elastic finite element analyses were performed in external torsion and dorsiflexion. The micromotions at the tibiotalar interface were computed to compare the two- and three-screw fixation in intact and flat-cut arthrodesis.
Results. Adding a third screw reduced the micromotions at the fusion site. Inserting the third screw anteriorly predicted lower peak micromotions than inserting the screw posteriorly, except for the intact arthrodesis tested in dorsiflexion. Three-screw intact arthrodesis predicted lower peak micromotions than flat-cut arthrodesis.
Conclusions. Better stability was predicted for three-screw ankle arthrodesis. In flat-cut arthrodesis, a third screw inserted anteriorly performed better than a posterior screw. In intact arthrodesis, a posterior screw seemed a better option when flexion stability was the main concern. Even with three-screw fixation, the configuration of the first two-crossed screws may still be important to improve the stability at the fusion site.
Relevance. The optimal number and placement of screws in ankle arthrodesis has yet to be determined. The differences in stability predicted between various screw configurations and surface preparation techniques presented here may be the difference between success and failure.
ankle arthrodesis, internal fixation, finite element, initial stability, micromotions, cancellous screws
0268-0033
751-759
Alonso-Vázquez, Ana
05e4e5db-a050-45b3-9b35-11b0ff356878
Lauge-Pederson, Henrik
9863cc67-d4f1-4dc7-b392-b9fc09277ce9
Lidgren, Lars
21daf4e7-a209-4b38-ba45-2a02a307dc73
Taylor, Mark
e368bda3-6ca5-4178-80e9-41a689badeeb
Alonso-Vázquez, Ana
05e4e5db-a050-45b3-9b35-11b0ff356878
Lauge-Pederson, Henrik
9863cc67-d4f1-4dc7-b392-b9fc09277ce9
Lidgren, Lars
21daf4e7-a209-4b38-ba45-2a02a307dc73
Taylor, Mark
e368bda3-6ca5-4178-80e9-41a689badeeb

Alonso-Vázquez, Ana, Lauge-Pederson, Henrik, Lidgren, Lars and Taylor, Mark (2004) Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis. Clinical Biomechanics, 19 (7), 751-759. (doi:10.1016/j.clinbiomech.2004.04.014).

Record type: Article

Abstract

Objective. Compare the initial stability at the fusion site of ankle arthrodesis fixed with two and three screws.
Design. Finite element models of ankle arthrodesis were developed from computed tomography images. Two-screw constructs were augmented with a third screw in different orientations and subjected to loads likely to affect the ankle postoperatively.
Background. More stable fixation seems to increase the chance of fusion, as it minimises the motion between the tibiotalar interfaces.
Methods. Non-linear elastic finite element analyses were performed in external torsion and dorsiflexion. The micromotions at the tibiotalar interface were computed to compare the two- and three-screw fixation in intact and flat-cut arthrodesis.
Results. Adding a third screw reduced the micromotions at the fusion site. Inserting the third screw anteriorly predicted lower peak micromotions than inserting the screw posteriorly, except for the intact arthrodesis tested in dorsiflexion. Three-screw intact arthrodesis predicted lower peak micromotions than flat-cut arthrodesis.
Conclusions. Better stability was predicted for three-screw ankle arthrodesis. In flat-cut arthrodesis, a third screw inserted anteriorly performed better than a posterior screw. In intact arthrodesis, a posterior screw seemed a better option when flexion stability was the main concern. Even with three-screw fixation, the configuration of the first two-crossed screws may still be important to improve the stability at the fusion site.
Relevance. The optimal number and placement of screws in ankle arthrodesis has yet to be determined. The differences in stability predicted between various screw configurations and surface preparation techniques presented here may be the difference between success and failure.

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More information

Published date: 2004
Keywords: ankle arthrodesis, internal fixation, finite element, initial stability, micromotions, cancellous screws

Identifiers

Local EPrints ID: 22933
URI: https://eprints.soton.ac.uk/id/eprint/22933
ISSN: 0268-0033
PURE UUID: 69311be6-c6ce-4af9-83c2-fd93431719f6

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Date deposited: 09 Mar 2006
Last modified: 15 Jul 2019 19:21

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Author: Ana Alonso-Vázquez
Author: Henrik Lauge-Pederson
Author: Lars Lidgren
Author: Mark Taylor

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