Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis
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 Fulkers...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | Journal of Orthopaedics and Traumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10195-023-00714-6 |
| _version_ | 1797789631983386624 |
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| author | Faruk Aykanat Ozkan Kose Bulent Guneri H. Kursat Celik Albert Cakar Ersin Tasatan Mihaela-Elena Ulmeanu |
| author_facet | Faruk Aykanat Ozkan Kose Bulent Guneri H. Kursat Celik Albert Cakar Ersin Tasatan Mihaela-Elena Ulmeanu |
| author_sort | Faruk Aykanat |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T01:53:26Z |
| format | Article |
| id | doaj.art-620e635d580145d0992ef5f52fb5d54e |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-03-13T01:53:26Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-620e635d580145d0992ef5f52fb5d54e2023-07-02T11:22:57ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992023-06-0124111310.1186/s10195-023-00714-6Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysisFaruk Aykanat0Ozkan Kose1Bulent Guneri2H. Kursat Celik3Albert Cakar4Ersin Tasatan5Mihaela-Elena Ulmeanu6Vocational School of Health Services, SANKO UniversityDepartment of Orthopedics and Traumatology, Antalya Training and Research HospitalDepartment of Orthopedics and Traumatology, Adana City Education and Research HospitalAgricultural Faculty, Department of Agricultural Machinery and Technology Engineering, Akdeniz UniversityDepartment of Orthopedics and Traumatology, Istanbul Training and Research HospitalDepartment of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City HospitalDepartment of Manufacturing, Polytechnic University of BucharestAbstract 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.https://doi.org/10.1186/s10195-023-00714-6Finite element analysisTibial tubercle osteotomyFulkerson osteotomyScrew fixationBiomechanics |
| spellingShingle | Faruk Aykanat Ozkan Kose Bulent Guneri H. Kursat Celik Albert Cakar Ersin Tasatan Mihaela-Elena Ulmeanu Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis Journal of Orthopaedics and Traumatology Finite element analysis Tibial tubercle osteotomy Fulkerson osteotomy Screw fixation Biomechanics |
| title | Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis |
| title_full | Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis |
| title_fullStr | Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis |
| title_full_unstemmed | Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis |
| title_short | Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis |
| title_sort | comparison of four different screw configurations for the fixation of fulkerson osteotomy a finite element analysis |
| topic | Finite element analysis Tibial tubercle osteotomy Fulkerson osteotomy Screw fixation Biomechanics |
| url | https://doi.org/10.1186/s10195-023-00714-6 |
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