Biomechanical evaluation of calcaneocuboid distraction arthrodesis: a cadaver study of two different fixation methods

Calcaneocuboid distraction arthrodesis can be used to treat stage 2 posterior tibial tendon dysfunction. Nonunion, graft resorption, and implant failure have been reported after this procedure. This study compared two of the most commonly used methods for fixation of calcaneocuboid distraction arthrodesis. Twelve pairs of cadaver feet underwent simulated calcaneocuboid distraction arthrodesis. One specimen in each pair was fixed with two crossed 3.5 mm cortical lag screws. The contralateral specimen was fixed with a cervical H-plate. The calcaneus was fixed and a load was applied to the plantar aspect of the cuboid at a rate of 5 mm/minute until joint separation of 3 mm or fracture occurred. The average applied load to failure at 1.0 mm of joint separation was 30.5 +/- 11.6 N for the crossed screws and 77.7 +/- 36.4 N for the cervical H-plate (p = 0.001). The average stiffness at 1.0 mm of joint separation was 27.5 +/- 10.9 N/mm for the crossed screws and 43 +/- 21.2 N/mm for the cervical H-plate (p = 0.036). The higher stiffness and load to failure may account for the decreased nonunion rate noted anecdotally by some surgeons with H-plate fixation over crossed screw fixation for calcaneocuboid distraction arthrodesis.