Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures.

MedStar author(s):
Citation: Foot & Ankle International. 42(1):89-95, 2021 Jan.PMID: 32981339Institution: MedStar Union Memorial HospitalDepartment: Curtis National Hand Center | Orthopaedic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Fractures, Avulsion/su [Surgery] | *Fractures, Bone/su [Surgery] | *Metatarsal Bones/su [Surgery] | Biomechanical Phenomena | Bone Plates | Bone Screws | Epiphyses/ph [Physiology] | Humans | PressureYear: 2021Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 1071-1007
Name of journal: Foot & ankle internationalAbstract: BACKGROUND: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures.CLINICAL RELEVANCE: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.CONCLUSION: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base.METHODS: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles.RESULTS: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 +/- 66.0 [range 100-300] cycles vs 178.6 +/- 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens.All authors: Abbasi P, Bean BA, Hembree WC, Parks BG, Smyth NAOriginally published: Foot & Ankle International. :1071100720953083, 2020 Sep 26Fiscal year: FY2022Digital Object Identifier: ORCID: Date added to catalog: 2020-10-06
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32981339 Available 32981339

Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures.

CLINICAL RELEVANCE: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.

CONCLUSION: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base.

METHODS: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles.

RESULTS: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 +/- 66.0 [range 100-300] cycles vs 178.6 +/- 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens.

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