PDF(Pubmed)
Abstract：
Introduction: Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various intramedullary screw fixation constructs. Methods: Jones fracture model over the proximal 5th metatarsal of artificial bone was created in all specimens. Six groups were divided based on varied screw constructs with different screw lengths, either 30 or 40 mm, including cannulated screws-C30 and C40 groups, one high-resistance suture combined with intramedullary cannulated screws (F.E.R.I. technique)-CF30 and CF40 groups, and second-generation headless compression screws (SG-HCS) -HL30 and HL40 groups. Mechanical testing was conducted sequentially, and the maximal force (N) and stiffness (N/mm) of all constructs were recorded. Results: The maximal force (N) at 1.0 mm downward displacement in C30, C40, CF30, CF40, HL30, and HL40 groups were 0.56 ± 0.02, 0.49 ± 0.02, 0.65 ± 0.02, 0.49 ± 0.01, 0.68 ± 0.02, and 0.73 ± 0.02, respectively, and the stiffness (N/mm) in subgroups were 0.49 ± 0.01, 0.43 ± 0.01, 0.67 ± 0.01, 0.42 ± 0.01, 0.61 ± 0.01, and 0.58 ± 0.02, respectively. SG-HCS subgroups exhibited greater maximal force and stiffness than conventional cannulated screws. Screws of 30 mm in length demonstrated better stability than all 40 mm-length screws in each subgroup. In C30 fixation, the stiffness and maximum force endured increased by 1.16 and 1.12 times, respectively, compared with the C40 fixation method. There were no significant differences between CF30 and SG-HCS groups. Only the F.E.R.I technique combined with the 4.5 mm cannulated screw of 30 mm in length increased the biomechanical stability for Jones fractures. Discussion: These biomechanical findings help clinicians decide on better screw fixation options for greater stability in Jones fractures, especially when large-diameter screws are limited in use. However, this biomechanical testing of intramedullary screw fixation on Jones fracture model lacks clinical validation and no comparisons to extramedullary plate fixations. Moving forward, additional clinical and biomechanical research is necessary to validate our findings.
摘要：
简介：琼斯骨折经常无法团结，和足够的固定稳定性是至关重要的。这项研究旨在阐明各种髓内螺钉固定结构的生物力学稳定性。方法：在所有标本中建立人工骨第5跖骨近端Jones骨折模型。根据不同螺钉长度的螺钉结构分为六组，30或40毫米，包括空心螺钉-C30和C40组，一根高阻缝线结合髓内空心螺钉(F.E.R.I.technical)-CF30和CF40组，和第二代无头压紧螺钉（SG-HCS）-HL30和HL40组。机械测试是按顺序进行的，记录所有构建体的最大力(N)和刚度(N/mm)。结果：C30，C40，CF30，CF40，HL30和HL40组向下位移1.0mm时的最大力（N）分别为0.56±0.02，0.49±0.02，0.65±0.02，0.49±0.01，0.68±0.02和0.73±0.02。亚组的刚度（N/mm）分别为0.49±0.01、0.43±0.01、0.67±0.01、0.42±0.01、0.61±0.01和0.58±0.02。SG-HCS亚组表现出比常规空心螺钉更大的最大力和刚度。在每个亚组中,30mm长度的螺钉表现出比所有40mm长度的螺钉更好的稳定性。在C30固定中，刚度和最大力分别增加了1.16和1.12倍，分别,与C40固定方法相比。CF30和SG-HCS组之间无显著差异。只有F.E.R.I技术与长度为30mm的4.5mm空心螺钉相结合，才能提高Jones骨折的生物力学稳定性。讨论：这些生物力学发现有助于临床医生决定更好的螺钉固定方案，以提高琼斯骨折的稳定性。特别是大直径螺钉在使用中受到限制时。然而,这项针对Jones骨折模型的髓内螺钉固定的生物力学测试缺乏临床验证,也无法与髓外钢板固定进行比较.往前走,需要进行更多的临床和生物力学研究来验证我们的发现.
