title: The Impact of Nitinol Staples on the Compressive Forces, Contact Area, and Mechanical Properties in Comparison to a Claw Plate and Crossed Screws for the First Tarsometatarsal Arthrodesis.
abstract: Background The optimal fixation method for the first tarsometatarsal arthrodesis remains controversial. This study aimed to develop a reproducible first tarsometatarsal testing model to evaluate the biomechanical performance of different reconstruction techniques. Methods Crossed screws or a claw plate were compared with a single or double shape memory alloy staple configuration in 20 Sawbones models. Constructs were mechanically tested in 4-point bending to 1, 2, and 3 mm of plantar displacement. The joint contact force and area were measured at time zero, and following 1 and 2 mm of bending. Peak load, stiffness, and plantar gapping were determined. Results Both staple configurations induced a significantly greater contact force and area across the arthrodesis than the crossed screw and claw plate constructs at all measurements. The staple constructs completely recovered their plantar gapping following each test. The claw plate generated the least contact force and area at the joint interface and had significantly greater plantar gapping than all other constructs. The crossed screw constructs were significantly stiffer and had significantly less plantar gapping than the other constructs, but this gapping was not recoverable. Conclusions Crossed screw fixation provides a rigid arthrodesis with limited compression and contact footprint across the joint. Shape memory alloy staples afford dynamic fixation with sustained compression across the arthrodesis. A rigid polyurethane foam model provides an anatomically relevant comparison for evaluating the interface between different fixation techniques. Clinical Relevance The dynamic nature of shape memory alloy staples offers the potential to permit early weight bearing and could be a useful adjunctive device to impart compression across an arthrodesis of the first tarsometatarsal joint.
  
  
  METHODS
  Therapeutic, Level V: Bench testing.
authors.affiliation: Institute for Foot and Ankle, Mercy Medical Centre, Baltimore, Maryland (AA, MM)Surgical and Orthopaedic Research Laboratories, University of New South Wales, Randwick, New South Wales, Australia (NAR, MHP, WRW).
authors.forename: Amiethab
authors.initials: A
authors.lastname: Aiyer
authors.affiliation: Institute for Foot and Ankle, Mercy Medical Centre, Baltimore, Maryland (AA, MM)Surgical and Orthopaedic Research Laboratories, University of New South Wales, Randwick, New South Wales, Australia (NAR, MHP, WRW).
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Russell
authors.affiliation: Institute for Foot and Ankle, Mercy Medical Centre, Baltimore, Maryland (AA, MM)Surgical and Orthopaedic Research Laboratories, University of New South Wales, Randwick, New South Wales, Australia (NAR, MHP, WRW).
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Pelletier
authors.affiliation: Institute for Foot and Ankle, Mercy Medical Centre, Baltimore, Maryland (AA, MM)Surgical and Orthopaedic Research Laboratories, University of New South Wales, Randwick, New South Wales, Australia (NAR, MHP, WRW).
authors.forename: Mark
authors.initials: M
authors.lastname: Myerson
authors.affiliation: Institute for Foot and Ankle, Mercy Medical Centre, Baltimore, Maryland (AA, MM)Surgical and Orthopaedic Research Laboratories, University of New South Wales, Randwick, New South Wales, Australia (NAR, MHP, WRW) w.walsh@unsw.edu.au.
authors.forename: William R
authors.initials: WR
authors.lastname: Walsh
mesh_terms: D000497:Alloys; D001174:Arthrodesis / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D033023:Foot Joints / Q000502:physiology / Q000601:surgery*; D006801:Humans; D008422:Materials Testing; D008682:Metatarsal Bones / Q000502:physiology / Q000601:surgery; D008953:Models, Anatomic; D013528:Surgical Staplers; D013537:Sutures; D013639:Tarsal Bones / Q000502:physiology / Q000601:surgery
chemical_list: D000497:Alloys; C013616:nitinol
keywords: Lapidus; biomechanical; nitinol; sawbone; staple