Highlights
- •Two constructs were tested for fixation of horizontal medial malleolus fractures.
- •Headless compression screw and unicortical cancellous screw were compared.
- •The headless compression screw construct had greater stiffness.
- •Headless compression screws had greater load at 2 mm of lateral displacement.
Abstract
Background
Horizontal medial malleolus fractures are caused by the application of rotational
force through the ankle joint in several orientations. Multiple techniques are available
for the fixation of medial malleolar fractures.
Methods
Horizontal medial malleolus osteotomies were performed in eighteen synthetic distal
tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous
screws or 2) two Acutrak 2 headless compression screws. Specimens were subjected to
offset axial tension loading. Frontal plane interfragmentary motion was monitored.
Findings
The headless compression group (1699 (SD 947) N/mm) had significantly greater proximal-distal
stiffness than the unicortical group (668 (SD 298) N/mm), (P = 0.012). Similarly, the headless compression group (604 (SD 148) N/mm) had significantly
greater medial-lateral stiffness than the unicortical group (281 (SD 152) N/mm), (P < 0.001). The force at 2 mm of lateral displacement was significantly greater in
the headless compression group (955 (SD 79) N) compared to the unicortical group (679
(SD 198) N), (P = 0.003). At 2 mm of distal displacement, the mean force was higher in the headless
compression group (1037 (SD 122) N) compared to the unicortical group (729 (SD 229)
N), but the difference was not significant (P = 0.131).
Interpretation
A headless compression screw construct was significantly stiffer in both the proximal-distal
and medial-lateral directions, indicating greater resistance to both axial and shear
loading. Additionally, they had significantly greater load at clinical failure based
on lateral displacement. The low-profile design of the headless compression screw
minimizes soft tissue irritation and reduces need for implant removal.
Keywords
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Article info
Publication history
Published online: March 27, 2018
Accepted:
March 26,
2018
Received:
June 22,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
