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Optimal double screw configuration for subtalar arthrodesis: a finite element analysis
1Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea.
Summary
The optimal double screw fixation for subtalar arthrodesis involves a posteromedial dome screw with a neck screw, enhancing initial mechanical stability and promoting excellent union rates for traumatic subtalar arthritis.
Area of Science:
- Orthopedic surgery
- Biomechanics
- Medical imaging
Background:
- Subtalar arthrodesis is a surgical procedure to fuse the talus and calcaneus bones.
- Traumatic subtalar arthritis often necessitates this fusion.
- While single screw fixation is common, double screw fixation offers potentially superior initial stability.
Purpose of the Study:
- To determine the optimal configuration for double screw fixation in subtalar arthrodesis.
- To compare the mechanical stability of different double screw placements.
Main Methods:
- Finite element analysis was used, based on CT scans of a Korean male's ankle.
- Polygon models of the talus and calcaneus were converted to tetrahedron elements.
- Four double screw configurations were simulated, applying rotational torques to assess stability.
Main Results:
- The combination of a neck screw and a posteromedial (PM) dome screw demonstrated the least translation and rotation under applied torques.
- Neither divergence angle nor contact length alone predicted stability.
- Combined analysis of divergence angle and screw-bone contact length correlated with improved rotational stability.
Conclusions:
- A surgical approach using a neck screw and a posteromedial dome screw provides the best mechanical stability for subtalar arthrodesis.
- This configuration is expected to yield excellent union rates in managing traumatic subtalar arthritis.
