Effect of headless compression screw on construct stability for centre of rotation and angulation-based levelling osteotomy

Summary

Objective: To compare the biomechanical properties of bone and implant constructs when used for the centre of rotation and angulation (CORA) based levelling osteotomy, with and without implantation of a trans-osteotomy headless compression screw tested under three-point flexural and torsional forces; thereby determining the contribution of a trans-osteotomy headless compression screw with regards to stability of the construct.

Methods: Experimental biomechanical study utilizing 12 pairs of cadaveric canine tibias. Using the CORA based levelling osteotomy (CBLO) procedure, the osteotomy was stabilized with either a standard non-locking CBLO bone plate augmented with a headless compression screw (HCS) or a CBLO bone plate alone. Tibial constructs were mechanically tested in three-point craniocaudal flexural testing or in torsion.

Results: In three-point flexural testing, the difference between the two constructs was not significant. In torsion, the difference in the angle of failure between constructs with a HCS (48.46°) and constructs without a HCS (81.65°) was significant (p = 0.036). Maximum torque achieved by constructs with a HCS (21.7 Nm) was greater than those without (18.7 Nm) (p = 0.056). Stiffness differences between both groups in torsion and bending were not significant. Use of a HCS did increase the stability of the CBLO construct in torsional testing, but not in flexural testing.

Keywords

Biomechanics - cranial cruciate ligament injury - centre of rotation and angulation - levelling osteotomy

• References

• 1 Kishi E, Hulse D. Owner evaluation of a CORA based leveling osteotomy for treatment of cranial cruciate ligament injury in dogs. Vet Surg 2016; 45: 507-514.
• 2 Paley D, Herzenberg JE, Tetsworth K. et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994; 25: 425-465.
• 3 Raske M, Hulse D, Beale B. et al. Stabilization of the CORA based leveling osteotomy for treatment of cranial cruciate ligament injury using a bone plate augmented with a headless compression screw. Vet Surg 2013; 42: 759-764.
• 4 Assari S, Darvish K, Ilyas AM. Biomechanical analysis of second-generation headless compression screws. Injury 2012; 43: 1159-1165.
• 5 Grewal R, Assini J, Sauder D. et al. A comparison of two headless compression screws for operative treatment of scaphoid fractures. J Orthop Surg Res 2011; 6: 27.
• 6 Vallotton M, Torcasio A. Biomechanical performance of headless compression screws: Fixos ø4.0, 5.0 & 7.0 mm compared to Synthes ø4.5 & 6.5 mm HCS. Selzach, Switzerland: Stryker Trauma AG; May. 2014 16. Content ID: FIX-WP-2 Re. 1. Available at https://footankle.stryker.com/en/products/screw-systems/fixos2-headless-compression-screws
• 7 Adla DN, Kitsis C, Miles A. Compression forces generated by mini bone screws-a comparative study done on bone model. Injury 2005; 36: 65-70.
• 8 Beadel GP, Ferreira L, Johnson JA. et al. Interfragmentary compression across a simulated scaphoid fracture—analysis of 3 screws. J Hand Surg 2004; 29: 273-278.
• 9 Hart MB, Wu JJ, Chao EY. et al. External skeletal fixation of canine tibial osteotomies. Compression compared with no compression. J Bone Joint Surg 1985; 67: 598.
• 10 Mayer G, Wolfs E. Animal experiments to examine the histology of fracture healing in osteosynthesis with external fixation and compression. Arch Orthop Trauma Surg 1983; 101: 111-120.
• 11 Gruszka DS, Burkhart KJ, Nowak TE. et al. The durability of the intrascaphoid compression of headless compression screws: In vitro study. J Hand Surg Am 2012; 37: 1142-1150.
• 12 Hutcheson KD, Butler JR, Elder SE. Comparison of double locking plate constructs with single non-locking plate constructs in single cycle to failure in bending and torsion. Vet Comp Orthop Traumatol 2015; 28: 234-239.
• 13 Leitner M, Pearce SG, Windolf M. et al. Comparison of locking and conventional screws for maintenance of tibial plateau positioning and biomechanical stability after locking tibial plateau leveling osteotomy plate fixation. Vet Surg 2008; 37: 357-365.