Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw
Abstract Objective Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical s...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01767-7 |
| _version_ | 1817993017301139456 |
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| author | Sen Wang Jian Yu Xin Ma Dahang Zhao Xiang Geng Jiazhang Huang Xu Wang |
| author_facet | Sen Wang Jian Yu Xin Ma Dahang Zhao Xiang Geng Jiazhang Huang Xu Wang |
| author_sort | Sen Wang |
| collection | DOAJ |
| description | Abstract Objective Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance. Methods We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle. Results Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum, 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean, 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw. Conclusion Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice. |
| first_indexed | 2024-04-14T01:34:09Z |
| format | Article |
| id | doaj.art-aa40a56379a348a1804e1a9bfd5183c8 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T01:34:09Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-aa40a56379a348a1804e1a9bfd5183c82022-12-22T02:20:04ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-07-011511910.1186/s13018-020-01767-7Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screwSen Wang0Jian Yu1Xin Ma2Dahang Zhao3Xiang Geng4Jiazhang Huang5Xu Wang6Department of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityDepartment of Orthopedics, Huashan Hospital, Fudan UniversityAbstract Objective Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance. Methods We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle. Results Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum, 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean, 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw. Conclusion Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice.http://link.springer.com/article/10.1186/s13018-020-01767-7Finite element methodScrew configurationBiomechanicsArthroscopic ankle arthrodesis |
| spellingShingle | Sen Wang Jian Yu Xin Ma Dahang Zhao Xiang Geng Jiazhang Huang Xu Wang Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw Journal of Orthopaedic Surgery and Research Finite element method Screw configuration Biomechanics Arthroscopic ankle arthrodesis |
| title | Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw |
| title_full | Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw |
| title_fullStr | Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw |
| title_full_unstemmed | Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw |
| title_short | Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw |
| title_sort | finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three screw fixation posteromedial versus posterolateral home run screw |
| topic | Finite element method Screw configuration Biomechanics Arthroscopic ankle arthrodesis |
| url | http://link.springer.com/article/10.1186/s13018-020-01767-7 |
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