Ankle joint biomechanics following transepiphyseal screw fixation of the distal tibia

Michael Charlton, Richard Costello, James F. Mooney, David A. Podeszwa

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Transepiphyseal screws have traditionally been removed after fixation of pediatric ankle fractures due to concerns about increased forces and contact pressures within the tibiotalar joint secondary to the implant. No study has assessed pressure across the ankle joint after such fixation. Seven adult and two pediatric cadaveric ankles underwent axial loading in a uniaxial material test machine. Each was tested before fixation (control), after fixation (screw in place), and after removal (after screw removal). Three sequential test runs at three loading conditions (approximate body weight, twice body weight, and five times body weight) were performed to simulate forces of standing and ambulation. Total force, peak contact pressure, and contact area were measured with an intraarticular sensor. After screw placement, all loads caused a significant increase in total force versus control. Peak contact pressures after placement also increased significantly. Screw removal subsequently led to a net decrease in force and peak pressure values. Total contact area was unchanged. Concerns regarding subchondral screws in the distal tibia appear warranted. Findings in this study support implant removal following union of such fractures.

Original languageEnglish (US)
Pages (from-to)635-640
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume25
Issue number5
DOIs
StatePublished - Sep 2005

Fingerprint

Ankle Joint
Tibia
Biomechanical Phenomena
Pressure
Body Weight
Pediatrics
Ankle Fractures
Weight-Bearing
Ankle
Walking
Joints

Keywords

  • Contact pressures
  • Implant removal
  • Tillaux fractures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Ankle joint biomechanics following transepiphyseal screw fixation of the distal tibia. / Charlton, Michael; Costello, Richard; Mooney, James F.; Podeszwa, David A.

In: Journal of Pediatric Orthopaedics, Vol. 25, No. 5, 09.2005, p. 635-640.

Research output: Contribution to journalArticle

Charlton, Michael ; Costello, Richard ; Mooney, James F. ; Podeszwa, David A. / Ankle joint biomechanics following transepiphyseal screw fixation of the distal tibia. In: Journal of Pediatric Orthopaedics. 2005 ; Vol. 25, No. 5. pp. 635-640.
@article{a1f54f846948445d8b8e54012200d09b,
title = "Ankle joint biomechanics following transepiphyseal screw fixation of the distal tibia",
abstract = "Transepiphyseal screws have traditionally been removed after fixation of pediatric ankle fractures due to concerns about increased forces and contact pressures within the tibiotalar joint secondary to the implant. No study has assessed pressure across the ankle joint after such fixation. Seven adult and two pediatric cadaveric ankles underwent axial loading in a uniaxial material test machine. Each was tested before fixation (control), after fixation (screw in place), and after removal (after screw removal). Three sequential test runs at three loading conditions (approximate body weight, twice body weight, and five times body weight) were performed to simulate forces of standing and ambulation. Total force, peak contact pressure, and contact area were measured with an intraarticular sensor. After screw placement, all loads caused a significant increase in total force versus control. Peak contact pressures after placement also increased significantly. Screw removal subsequently led to a net decrease in force and peak pressure values. Total contact area was unchanged. Concerns regarding subchondral screws in the distal tibia appear warranted. Findings in this study support implant removal following union of such fractures.",
keywords = "Contact pressures, Implant removal, Tillaux fractures",
author = "Michael Charlton and Richard Costello and Mooney, {James F.} and Podeszwa, {David A.}",
year = "2005",
month = "9",
doi = "10.1097/01.bpo.0000161834.65032.c5",
language = "English (US)",
volume = "25",
pages = "635--640",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Ankle joint biomechanics following transepiphyseal screw fixation of the distal tibia

AU - Charlton, Michael

AU - Costello, Richard

AU - Mooney, James F.

AU - Podeszwa, David A.

PY - 2005/9

Y1 - 2005/9

N2 - Transepiphyseal screws have traditionally been removed after fixation of pediatric ankle fractures due to concerns about increased forces and contact pressures within the tibiotalar joint secondary to the implant. No study has assessed pressure across the ankle joint after such fixation. Seven adult and two pediatric cadaveric ankles underwent axial loading in a uniaxial material test machine. Each was tested before fixation (control), after fixation (screw in place), and after removal (after screw removal). Three sequential test runs at three loading conditions (approximate body weight, twice body weight, and five times body weight) were performed to simulate forces of standing and ambulation. Total force, peak contact pressure, and contact area were measured with an intraarticular sensor. After screw placement, all loads caused a significant increase in total force versus control. Peak contact pressures after placement also increased significantly. Screw removal subsequently led to a net decrease in force and peak pressure values. Total contact area was unchanged. Concerns regarding subchondral screws in the distal tibia appear warranted. Findings in this study support implant removal following union of such fractures.

AB - Transepiphyseal screws have traditionally been removed after fixation of pediatric ankle fractures due to concerns about increased forces and contact pressures within the tibiotalar joint secondary to the implant. No study has assessed pressure across the ankle joint after such fixation. Seven adult and two pediatric cadaveric ankles underwent axial loading in a uniaxial material test machine. Each was tested before fixation (control), after fixation (screw in place), and after removal (after screw removal). Three sequential test runs at three loading conditions (approximate body weight, twice body weight, and five times body weight) were performed to simulate forces of standing and ambulation. Total force, peak contact pressure, and contact area were measured with an intraarticular sensor. After screw placement, all loads caused a significant increase in total force versus control. Peak contact pressures after placement also increased significantly. Screw removal subsequently led to a net decrease in force and peak pressure values. Total contact area was unchanged. Concerns regarding subchondral screws in the distal tibia appear warranted. Findings in this study support implant removal following union of such fractures.

KW - Contact pressures

KW - Implant removal

KW - Tillaux fractures

UR - http://www.scopus.com/inward/record.url?scp=24144469994&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24144469994&partnerID=8YFLogxK

U2 - 10.1097/01.bpo.0000161834.65032.c5

DO - 10.1097/01.bpo.0000161834.65032.c5

M3 - Article

C2 - 16199946

AN - SCOPUS:24144469994

VL - 25

SP - 635

EP - 640

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 5

ER -