The use of calcium sulfate and calcium phosphate composite graft to augment screw purchase in osteoporotic ankles.
BACKGROUND
Screws placed in the distal fibula may not have satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study was to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft into the drill holes prior to insertion of the screws.


METHODS
Bone density was quantified using a DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into the screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion in an MTS machine.


RESULTS
After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement (p = 0.018 distal, p = 0.0093 proximal), failure load, (p = 0.0185 distal, p = 0.0238 proximal), and failure energy (p = 0.0071 distal, p = 0.0115 proximal) between augmented and non-augmented screws, with the augmented screws being considerably stronger.


CONCLUSIONS
Screws augmented with composite graft provide significantly greater purchase in an osteoporotic fibular fracture model.


CONCLUSIONS
Composite graft augmented screws inserted into the distal tibia from the fibula may enhance the stability of internal fixation of an osteoporotic ankle fracture. This may enable earlier weightbearing and return to function which is important in elderly patients.
Orthopedics, The University of Texas Medical Branch, Galveston, TX 77555-0165, USA. vkpanchb@utmb.edu
Vinod K
VK
Panchbhavi
Santaram
S
Vallurupalli
Randal
R
Morris
Rita
R
Patterson
D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D001843:Bone Cements / Q000627:therapeutic use*; D015519:Bone Density; D001863:Bone Screws; D002102:Cadaver; D002130:Calcium Phosphates / Q000627:therapeutic use*; D002133:Calcium Sulfate / Q000627:therapeutic use*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008422:Materials Testing; D008875:Middle Aged; D010024:Osteoporosis / Q000601:surgery*
D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate; D002133:Calcium Sulfate