Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

Miko Lin Lv; Ming Ni; Wanju Sun; Duo Wai-Chi Wong; Shuren Zhou; Yongwei Jia; Ming Zhang

doi:10.3389/fbioe.2022.791554

Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

Front Bioeng Biotechnol. 2022 Mar 9:10:791554. doi: 10.3389/fbioe.2022.791554. eCollection 2022.

Authors

Miko Lin Lv¹, Ming Ni², Wanju Sun², Duo Wai-Chi Wong³, Shuren Zhou⁴, Yongwei Jia⁵, Ming Zhang³

Affiliations

¹ School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
² Department of Orthopedics, Pudong New Area People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
³ Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
⁴ School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha, China.
⁵ Department of Spine Surgery, Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel "double-point fixation" for calcaneal fractures and compare its biomechanical stability with the traditional "three-point fixation." A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane's angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane's angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.

Keywords: calcaneal locking plate; displaced intra-articular calcaneal fracture; finite element method; internal fixation; volar distal radial plate.