title: Intramedullary rod fixation compared with blade-plate-and-screw fixation for tibiotalocalcaneal arthrodesis: a biomechanical investigation.
abstract: BACKGROUND
  Achieving stable fixation when performing tibiotalocalcaneal arthrodesis can be challenging, especially in osteopenic bone. The purpose of the current investigation was to compare the stiffness and fatigue endurance of blade-plate-and-screw fixation with intramedullary rod fixation in a cadaveric model.
  
  
  METHODS
  In ten matched pairs of fresh-frozen cadaveric legs, a tibiotalocalcaneal arthrodesis was performed with use of a blade-plate and a 6.5-mm sagittal screw in one leg and with use of an intramedullary rod in the contralateral leg. After an initial load-deformation curve was obtained, each specimen was loaded to 270 N through 250,000 cycles at a rate of 3 Hz.
  
  
  RESULTS
  Blade-plate-and-screw fixation resulted in significantly higher mean initial and final stiffness and decreased plastic deformation than did intramedullary rod fixation. In addition, there was an inverse correlation between bone-mineral density and the difference in plastic deformation noted between the specimens of each pair.
  
  
  CONCLUSIONS
  Blade-plate fixation is biomechanically superior to intramedullary fixation for tibiotalocalcaneal arthrodesis.
authors.affiliation: Department of Orthopaedic Surgery, Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Chiodo
authors.forename: Jorge I
authors.initials: JI
authors.lastname: Acevedo
authors.forename: V James
authors.initials: VJ
authors.lastname: Sammarco
authors.forename: Brent G
authors.initials: BG
authors.lastname: Parks
authors.forename: Henry R
authors.initials: HR
authors.lastname: Boucher
authors.forename: Mark S
authors.initials: MS
authors.lastname: Myerson
authors.forename: Lew C
authors.initials: LC
authors.lastname: Schon
mesh_terms: D000704:Analysis of Variance; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D002111:Calcaneus / Q000601:surgery; D019245:Compressive Strength; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008297:Male; D011336:Probability; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013977:Tibia / Q000601:surgery