Clinical biomechanics (Bristol, Avon) · 2025
Retrograde intramedullary headless compression screw fixation for distal fibular fractures.
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Bellapianta Joseph, Winnier Scott, Souflis George Anastasios, Viggiano Michael K
Аннотация
BACKGROUND: Although intramedullary headless compression screw fixation for distal fibular fractures has been described, its biomechanical properties remain underexplored in orthopedic literature. Distal fibular fractures are commonly treated with plate-and-screw constructs; however, complications related to hardware prominence, soft tissue irritation, and hardware removal are frequent. Retrograde intramedullary headless compression screw fixation may offer a biomechanically stable, minimally invasive alternative.
OBJECTIVE: To biomechanically compare retrograde intramedullary headless compression screw fixation with traditional 7-hole one-third tubular plate and lag screw fixation in simulated Weber B distal fibular fractures using cadaveric models.
METHODS: Twenty match-paired cadaver fibulas were artificially fractured and repaired with either intramedullary screw or plate fixation. The specimens underwent four-point bending and torsional tests to assess biomechanical stability. Paired t-tests were used for comparisons, with effect sizes and confidence intervals reported.
FINDINGS: Intramedullary headless compression screw fixation demonstrated greater stability during compression testing, but this difference was not statistically significant (p = 0.1326). The mean difference in maximum compressive load was 28.108 N (95 % CI [-11.43, 67.65]). No significant differences were observed in torsion testing, with a mean difference of -14.411 N·cm (95 % CI [-35.70, 6.88]). The study had low statistical power (0.052) to detect differences.
INTERPRETATIONS: Retrograde intramedullary screw fixation provides comparable or superior biomechanical stability to plate-and-screw constructs in a cadaveric model. This technique may be a viable alternative in select fracture patterns, warranting further clinical investigation.
OBJECTIVE: To biomechanically compare retrograde intramedullary headless compression screw fixation with traditional 7-hole one-third tubular plate and lag screw fixation in simulated Weber B distal fibular fractures using cadaveric models.
METHODS: Twenty match-paired cadaver fibulas were artificially fractured and repaired with either intramedullary screw or plate fixation. The specimens underwent four-point bending and torsional tests to assess biomechanical stability. Paired t-tests were used for comparisons, with effect sizes and confidence intervals reported.
FINDINGS: Intramedullary headless compression screw fixation demonstrated greater stability during compression testing, but this difference was not statistically significant (p = 0.1326). The mean difference in maximum compressive load was 28.108 N (95 % CI [-11.43, 67.65]). No significant differences were observed in torsion testing, with a mean difference of -14.411 N·cm (95 % CI [-35.70, 6.88]). The study had low statistical power (0.052) to detect differences.
INTERPRETATIONS: Retrograde intramedullary screw fixation provides comparable or superior biomechanical stability to plate-and-screw constructs in a cadaveric model. This technique may be a viable alternative in select fracture patterns, warranting further clinical investigation.