The use of calcium sulfate and calcium phosphate composite graft to augment screw purchase in osteoporotic ankles.

نویسندگان

  • Vinod K Panchbhavi
  • Santaram Vallurupalli
  • Randal Morris
  • Rita Patterson
چکیده

BACKGROUND Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws. MATERIALS AND METHODS Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine. RESULTS After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger. CONCLUSION Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model. CLINICAL RELEVANCE Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?

Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both ...

متن کامل

Chemical Preparation of Beta Calcium Sulfate Hemihydrate Granules with a Special Particle Size as Bone Graft Material

Introduction: Beta calcium sulfate hemihydrate (BCSH), which is commonly known as “Gypsum plaster” has long been used as bone graft material because of its excellent biocompatibility and the ability for bone regeneration. Several methods have been used for the preparation of BCSH, including heat treatment of calcium sulfate dihydrate with water, application of inorganic acids or condensed inorg...

متن کامل

Use of a calcium sulfate-calcium phosphate synthetic bone graft composite in the surgical management of primary bone tumors.

Benign primary bone tumors are commonly treated with intralesional curettage with or without the use of surgical adjuvants. The reconstructive approach to the resulting contained bone defects is controversial, and clinical practice is varied. Synthetic bone substitutes may provide early mechanical support while minimizing the risks of disease transmission, nonunion, infection, and donor-site mo...

متن کامل

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model

Study Design Mechanical study. Purpose To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Overview of Literature Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-...

متن کامل

Calcium phosphate cement augmentation of cancellous bone screws can compensate for the absence of cortical fixation.

An obvious means to improve the fixation of a cancellous bone screw is to augment the surrounding bone with cement. Previous studies have shown that bone augmentation with Calcium Phosphate (CaP) cement significantly improves screw fixation. Nevertheless, quantitative data about the optimal distribution of CaP cement is not available. The present study aims to show the effect of cement distribu...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Foot & ankle international

دوره 29 6  شماره 

صفحات  -

تاریخ انتشار 2008