Comparative Biomechanical Evaluation of Bicortical Screw Versus Plate Fixation in Jones Fractures of the Fifth Metatarsal Using 3D-Printed Models.

Background

Jones fractures of the 5th metatarsal are frequently associated with nonunion due to limited vascularization and repetitive mechanical stress. The aim of the study was to compare the biomechanical performance of T-plate and bicortical screw fixation using standardized 3D models.

Methods

Three-dimensional models of the 5th metatarsal were generated from CT images and printed using PolyJet technology (Stratasys J5 DentaJet) using a rigid-elastic composite with properties similar to cortical and cancellous bone. Jones fractures were fixed with either a locked T-plate or a bicortical screw. The samples were tested under axial and oblique static loads (α = 0°, 90°, 180°) and for three values of interfragmentary distance (d = 0.1-1 mm), in a 3 × 2 factorial design.

Results

The T-plate fixation recorded a maximum yield force (Fmax) of 149.78 ± 8.53 N (138-161 N), significantly higher compared to the bicortical screw -98.56 ± 2.58 N (96-101 N), (p < 0.05). The ductility index was higher for the plate, indicating a progressive transition to yield. The α and d factors significantly influenced the mechanical behavior, with the polynomial model explaining over 95% of the total variation. Discussion: The plate fixation demonstrated greater strength and superior biomechanical tolerance in imperfect reduction scenarios. The main limitation is the lack of fatigue testing and the inability of 3D models to reproduce the structural heterogeneity of human bone.

Conclusions

Implant selection should be individualized based on fracture stability. 3D models provide a reproducible platform for comparative evaluation of osteosynthesis methods, but future studies should include cyclic loading and biological validation.