Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Optimal double screw configuration for subtalar arthrodesis: a finite element analysis

Abstract

Purpose

The subtalar arthrodesis using screws has been performed to manage traumatic subtalar arthritis. Even though clinically there might not have been big difference between using single screw or double screws for subtalar arthrodesis, a double screw fixation is expected to bring a better initial stability in a mechanical view. This study aimed to assess the optimal configuration of double screw fixation for subtalar arthrodesis.

Methods

From the CT-scanned images of an ankle of a Korean male (21 year old), polygon models of the talus and calcaneus were reconstructed. The polygon models were converted to tetrahedron finite elements. Young’s modulus was assigned locally to each element based on the Hounsfield unit, and a Poisson’s ratio of 0.4 was commonly. Four fixation configurations of double screw subtalar arthrodesis were modeled by combination of a same placement of a neck screw and one of four different placements of a dome screw, i.e., anterolateral (AL), anteromedial (AM), posterolateral (PL), and posteromedial (PM) placements. External and internal rotation torques of 4 N-m were applied when evaluating the stability of each fixation configuration.

Results

Among the four fixation configurations, the fixation configuration of a neck screw plus a PM dome screw had the least translation of 0.9 and 0.8 mm for external and internal rotational torques of 4 N-m, respectively. The fixation configuration of a neck screw plus a PM dome screw showed the least rotation of 5.0° and 4.8° for external and internal rotational torques of 4 N-m, respectively. The divergence angle or the contact length did not solely match well to the better stability. However, the integration of both the divergence angle of 2 screws and the contact length between screw and bones were proportionally related to the better rotational stability.

Conclusion

A posteromedial dome screw combined with a neck screw can be the best surgical choice, which will bring out excellent union rate of the subtalar arthrodesis as well as the best mechanical stability.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Alonso-Vazquez A, Lauge-Pedersen H, Lidgren L, Taylor M (2004) The effect of bone quality on the stability of ankle arthrodesis. A finite element study. Foot Ankle Int 25:840–850

  2. 2.

    Alonso-Vazquez A, Lauge-Pedersen H, Lidgren L, Taylor M (2004) Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis. Clin Biomech 19:751–759

  3. 3.

    Beimers L, de Leeuw PA, van Dijk CN (2009) A 3-portal approach for arthroscopic subtalar arthrodesis. Knee Surg Sports Traumatol Arthrosc 17:830–834

  4. 4.

    Chahal J, Stephen DJ, Bulmer B, Daniels T, Kreder HJ (2006) Factors associated with outcome after subtalar arthrodesis. J Orthop Trauma 20:555–561

  5. 5.

    Christen D, Webster DJ, Muller R (2010) Multiscale modelling and nonlinear finite element analysis as clinical tools for the assessment of fracture risk. Philos Transact A Math Phys Eng Sci 368:2653–2668

  6. 6.

    Chuckpaiwong B, Easley ME, Glisson RR (2009) Screw placement in subtalar arthrodesis: a biomechanical study. Foot Ankle Int 30:133–141

  7. 7.

    Clare MP, Lee WE 3rd, Sanders RW (2005) Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. J Bone Joint Surg Am 87:963–973

  8. 8.

    Cowin SC (1983) The mechanical and stress adaptive properties of bone. Ann Biomed Eng 11:263–295

  9. 9.

    Dahm DL, Kitaoka HB (1998) Subtalar arthrodesis with internal compression for post-traumatic arthritis. J Bone Joint Surg Br 80:134–138

  10. 10.

    Davies MB, Rosenfeld PF, Stavrou P, Saxby TS (2007) A comprehensive review of subtalar arthrodesis. Foot Ankle Int 28:295–297

  11. 11.

    Dennyson WG, Fulford GE (1976) Subtalar arthrodesis by cancellous grafts and metallic internal fixation. J Bone Joint Surg Br 58-B:507–510

  12. 12.

    Diezi C, Favre P, Vienne P (2008) Primary isolated subtalar arthrodesis: outcome after 2 to 5 years followup. Foot Ankle Int 29:1195–1202

  13. 13.

    Easley ME, Trnka HJ, Schon LC, Myerson MS (2000) Isolated subtalar arthrodesis. J Bone Joint Surg Am 82:613–624

  14. 14.

    Frigg A, Dougall H, Boyd S, Nigg B (2010) Can porous tantalum be used to achieve ankle and subtalar arthrodesis? a pilot study. Clin Orthop Relat Res 468:209–216

  15. 15.

    Gable SJ, Bohay DR, Manoli A 2nd (1995) Aiming guide for accurate placement of subtalar joint screws. Foot Ankle Int 16:238–239

  16. 16.

    Gosch C, Verrette R, Lindsey DP, Beaupre GS, Lehnert B (2006) Comparison of initial compression force across the subtalar joint by two different screw fixation techniques. J Foot Ankle Surg 45:168–173

  17. 17.

    Hedstrom M (2004) Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment? A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures. Acta Orthop Scand 75:50–52

  18. 18.

    Huefner T, Thermann H, Geerling J, Pape HC, Pohlemann T (2001) Primary subtalar arthrodesis of calcaneal fractures. Foot Ankle Int 22:9–14

  19. 19.

    Joveniaux P, Harisboure A, Ohl X, Dehoux E (2010) Long-term results of in situ subtalar arthrodesis. Int Orthop 34:1199–1205

  20. 20.

    Kaneko TS, Pejcic MR, Tehranzadeh J, Keyak JH (2003) Relationships between material properties and CT scan data of cortical bone with and without metastatic lesions. Med Eng Phys 25:445–454

  21. 21.

    Lee KB, Saltzman CL, Suh JS, Wasserman L, Amendola A (2008) A posterior 3-portal arthroscopic approach for isolated subtalar arthrodesis. Arthroscopy 24:1306–1310

  22. 22.

    Lehnert B, Gosch C, Sims GE (2004) A plantar approach for fixation of subtalar joint arthrodesis. J Foot Ankle Surg 43:67–69

  23. 23.

    McGlamry MC, Robitaille MF (2004) Analysis of screw pullout strength: a function of screw orientation in subtalar joint arthrodesis. J Foot Ankle Surg 43:277–284

  24. 24.

    Thermann H, Hufner T, Schratt HE, Held C, Tscherne H (1999) Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results. Unfallchirurg 102:13–22

  25. 25.

    Vazquez AA, Lauge-Pedersen H, Lidgren L, Taylor M (2003) Finite element analysis of the initial stability of ankle arthrodesis with internal fixation: flat cut versus intact joint contours. Clin Biomech 18:244–253

  26. 26.

    Weindel S, Schmidt R, Rammelt S, Claes L, Campe AV, Rein S (2008) Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130:313–319

  27. 27.

    Zwipp H, Rammelt S, Endres T, Heineck J (2010) High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res 468:958–968

Download references

Conflict of interest

None.

Author information

Correspondence to Yeon Soo Lee.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00167-011-1451-y

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lee, J.Y., Lee, Y.S. Optimal double screw configuration for subtalar arthrodesis: a finite element analysis. Knee Surg Sports Traumatol Arthrosc 19, 842–849 (2011). https://doi.org/10.1007/s00167-010-1383-y

Download citation

Keywords

  • Ankle
  • Calcaneus
  • Talus
  • Subtalar arthrodesis
  • Screw fixation
  • Finite element analysis