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Categories: Abstracts, 2025-Nov, Podium

A Cadaver Biomechanical Comparison of the Plate Construct for Open Lapidus Fusion versus Percutaneous Lapidus Fusion Using Subchondral Fixation

Alastair Younger, Stephen Steinlauf, Nathan Webb, Brian Thoren, Douglas Linton

University of British Columbia, Vancouver, Canada

Introduction: Tarsometatarsal (TMT) fusions traditionally use bridge plates or compression screws through open incisions to correct deformity and achieve bone healing. A new percutaneous technique can remove cartilage, preserve the subchondral bone and transfix the fusion site. Intraosseus, headless, chamfered, full-thread, non-variable pitch screws are used to transfix all available bone. This study compared the biomechanical properties of the plate construct versus the percutaneous construct.

Method: TMT joints of six cadavers (12 limbs) were stabilized with a locking plate and 3.5 mm compression screw on one limb, and with a percutaneous Lapidus construct on the matched limb. An extensometer was placed on the plantar side of the TMT. The first metatarsal was point loaded cyclically from 9 to 90 N at 60 mm from the TMT joint at 3 Hz. Testing was stopped if the extensometer reached 7 mm of plantar gap, or when 250,000 cycles were reached. Specimens were then statically loaded to failure.

Results: Percutaneous screw specimens reached more cycles to failure at 226,000 ± 58,000 versus 30,000 ± 52,000 for the open plate construct (p<.001). Plantar gap was higher in the open plate construct at all cycle counts from 10 to 10,000 cycles (>4 mm) versus the percutaneous group (<1 mm). Maximum load was higher in the percutaneous group (343.3 ± 92.8 N versus 247.3 ± 28.3 N) (p<.05). Stiffness of the percutaneous group was higher (40.9 ± 13.4 N/mm versus 16.0 ± 5.3 N/mm) (p<.01). No differences were found in bone quality testing. A Cox proportional hazard model identified the mode of fixation as the only significant covariant (p<.05) in predicting cycles to failure.

Conclusion: The percutaneous subchondral fixation fusion construct with full-thread, non-variable pitch, intraosseous screws create a stiffer and stronger fixation construct than dorsal plates and cross-screws.

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Tags: Arthrodesis Basic Science

Documents to download

FP22 - A Cadaver Biomechanical Comparison of Plate construct vs perc Alastair Younger.pdf(.pdf, 2.47 MB) - 17 download(s)

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