Comparison of the syndesmotic staple to the transsyndesmotic screw:​ a biomechanical study

Marqueen, Timothy; Owen, John; Nicandri, Gregg; Wayne, Jennifer; Carr, James

Affiliations

¹Department of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 980694, USA

Abstract and keywords

Background: Controv ersy still exists about treatment of syndesmotic injuries. This study compared the fixation strengths and biomechanical characteristics of two types of ankle fracture syndesmotic fixation devices: the barbed, round staple and the 4.5-mm cortical screw.

Methods: Cadaveric testing was done on 21 fresh-frozen knee disarticulation specimens in biaxial servohydraulic Instron testing equipment. Submaximal torsional loads were applied to specimens in intact and Weber C bimalle-olar fracture states. The specimens were then fixed with one of two techniques and again subjected to submaximal torsion and torsion to failure. Biomechanical parameters measured included tibiofibular translation and rotation, maximal torque to failure, and degrees of rotation at failure.

Results: Compared to the intact state before testing, the staple held the fibula in a more anatomic position than the screw for mediolateral and anterior displacements (p < 0.01). With submaximal torsional testing, the staple restored 85% of the tibiofibular external rotation and all of the posterior translation values as compared to the intact state. The screw resulted in 203% more tibiofibular medial translation and 115% more external rotation than the intact state. The degree of tibial rotation during submaximal torsional loading was restored to within 15% of intact values but was 21% less with the screw. There was no statistical difference between the screw and staple when tested in load to failure. Tibio-talar rotation at failure was statistically different with the staple construct, allowing more rotation as compared to the screw.

Conclusion: The staple restored a more physiologic position of the fibula compared to the syndesmotic screw. Both provided similar performance for the load to failure testing, while the screw reduced tibial rotation more after cyclic loading. There was more tibial rotation before failure for the staple, suggesting a more elastic construct. This study provides biomechanical data to support the clinical use of the syndesmotic staple.

Keywords: Ankle Fracture; Fixation Strength; Tibiofibular Motion; Torsion

Links

PubMed: 15766425

WoS: 000227500600006

Cited Works (16)

Year	Entry
1976	Scranton PE Jr, McMaster JH, Kelly E. Dynamic fibular function: a new concept. Clin Orthop Relat Res. July–August 1976;118:76-81.
1990	Stiehl JB. Complex ankle fracture dislocations with syndesmotic diastasis. Orthop Rev. June 1990;19(6):499-507.
1989	Needleman RL, Skrade DA, Stiehl JB. Effect of the syndesmotic screw on ankle motion. Foot Ankle. August 1989;10(1):17-24.
1985	Olerud C. The effect of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg. 1985;104(5):299-302.
1977	Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg. March 1977;59A(2):169-173.
1989	Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw: a cadaver study. J Bone Joint Surg. December 1989;71A(10):1548-1555.
1952	Barnett CH, Napier JR. The axis of rotation at the ankle joint in man: its influence upon the form of the talus and the mobility of the fibula. J Anat. January 1952;86(1):1-9.
1980	McCullough CJ, Burge PD. Rotatory stability of the load-bearing ankle: an experimental study. J Bone Joint Surg. November 1980;62B(4):460-464.
1994	Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma. June 1994;8(3):215-219.
1997	Thordarson DB, Hedman TP, Gross D, Magre G. Biomechanical evaluation of polylactide absorbable screws used for syndesmosis injury repair. Foot Ankle Int. October 1997;18(10):622-627.
1985	de Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg. September 1985;67A(7):1066-1074.
1994	Yamaguchi K, Martin CH, Boden SD, Labropoulos PA. Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: a prospective clinical study. Foot Ankle Int. August 1994;15(8):407-414.
1989	Lundberg A, Goldie I, Kalin B, Selvik G. Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion. Foot Ankle Int. February 1989;9(4):194-200.
2001	Tornetta P III, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg. April 2001;83A(4):489-492.
1956	Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg. July 1956;38A(4):761-781.
1976	Inman VT. The Joints of the Ankle. Baltimore, MD: Williams & Wilkins; 1976.

Cited By (6)

Year	Entry
2006	Bloemers FW, Bakker FC. Acute ankle syndesmosis injury in athletes. Euro J Trauma. 2006;32(4):350-356.
2007	van den Bekerom MPJ, Raven EEJ. Current concepts review: operative techniques for stabilizing the distal tibiofibular syndesmosis. Foot Ankle Int. December 2007;28(12):1302-1308.
2007	ElRayes M, Hammod A. Screw versus staple in stabilization of diastasis of tibiofibular syndesmosis. Foot Ankle Surg. 2007;13(1):5-9.
2007	Liacouras PC, Wayne JS. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng. 2007;129(6):811-817.
2008	Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg. April 2008;90B(4):405-410.
2006	Liacouras PC. Computational Modeling to Predict Mechanical Function of Joints: Validations and Applications of Lower Leg Simulations [PhD thesis]. Richmond, VA: Virginia Commonwealth University; August 2006.