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Internal Fixation Bone Mass Index (IFBM) and Biomechanical Performance of Different Fixation Methods for Herscovici
Ying Zhang1, Zhenjun Zhang1, Pan Hao1
1Department of Orthopedic Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong, China.
Background:
Optimal fixation for Herscovici type B and type C medial malleolar fractures because of debated due to differences in fragment size and loading conditions.
Purpose:
This study introduces the theoretical concept of Internal Fixation Bone Mass Index (IFBM) and compares three fixation methods under multidirectional loading.
Study Design:
Biomechanical study using Synbone® artificial tibia models.
Methods:
Synbone® tibia models simulated type B (small fragment, n=27) and type C (large fragment, n=27) fractures. Three fixation methods-cannulated screws (CS, 4.0 mm), fully threaded cancellous screws (FTCS, 4.0 mm), and Kirschner wires (KW, 1.5 mm)-were tested under axial, transverse, and traction loading using an Instron® 5969 machine. IFBM was defined as A_implant/A_bone.
Results:
For type B fractures, KW showed a higher 2 mm displacement load under traction than CS (65 ± 11 N vs. 31 ± 9 N; post-hoc p = 0.008) and FTCS (65 ± 11 N vs. 36 ± 12 N; post-hoc p = 0.012), with no statistically significant difference under axial and transverse loading (ANOVA p = 0.231 and p = 0.501). For type C fractures, CS and FTCS showed higher stability than KW under transverse and traction loading (ANOVA p = 0.004 and p = 0.003); no statistically significant difference was detected under axial loading (ANOVA p = 0.167).
Conclusions:
Fixation performance differed by fracture type. KW showed favorable performance for type B fractures, whereas screw fixation (CS or FTCS) demonstrated superior performance for type C fractures. IFBM is a theoretical metric that requires clinical validation.
