A comparison of conventional versus locking plates in intraarticular calcaneus fractures: A biomechanical study in human cadavers

• Published in: Clinical biomechanics (Bristol) 2007-01, Vol.22 (1), p.100-105
• Main Authors: Stoffel, Karl, Booth, Grant, Rohrl, Stephan M, Kuster, Markus
• Format: Article
• Language: English
• Subjects: Aged; Biomechanical Phenomena - methods; Biomechanical testing; Bone and Bones - anatomy & histology; Bone and Bones - pathology; Bone Density; Cadaver; Calcaneal fracture; Conventional screws; Female; Fracture Fixation, Internal - methods; Fractures, Bone - diagnosis; Fractures, Bone - pathology; Humans; Internal Fixators; Locked screws; Lower Extremity - pathology; Male; Materials Testing; Osteoporosis - pathology; Physical Medicine and Rehabilitation; Plate fixation; Stress, Mechanical; Tensile Strength
• ISSN: 0268-0033; 1879-1271
• DOI: 10.1016/j.clinbiomech.2006.07.008

Abstract Background Internal fixation of displaced intraarticular calcaneal fractures in patients older than 50 years remains controversial. This is, in many cases, due to fear of loss of fixation and the risk of implant failure in osteoporotic bone. It is the objective of this study to compare the fixation strength obtained using calcaneal plates with and without locking screws, in the fixation of osteoporotic cadaveric intraarticular calcaneal fractures. Methods In seven pairs of fresh frozen lower limbs cadavers, intraarticular calcaneal fractures were created with a dynamic single impact loading device and stabilized using either the low profile locking plate, or the conventional calcaneus plate. Radiographs were obtained to assess reduction. The specimens were then subjected to cyclic loading followed by loading to failure, using matched pairs of cadaveric lower limbs. The Wilcoxon signed rank test was used to test for differences in the results. Findings The locking plate showed a significant lower irreversible deformation during cyclic loading and a significant higher load to failure. The difference between the ultimate displacement, and work to failure was not significant. A low bone mineral content in the area of the posterior facet correlated only in the conventional plate group with increased irreversible deformation. Interpretation This study supports the mechanical viability of using locking calcaneal plates for the fixation of intraarticular calcaneal fractures in elderly patients.