Effect of lag screw on stability of first metatarsophalangeal joint arthrodesis with medial plate.

Background: First metatarsophalangeal joint (MTP-1) arthrodesis is a commonly performed procedure in the treatment of disorders of the great toe. Since the incidence of revision after MTP-1 joint arthrodesis is not insignificant, a medial approach with a medially positioned locking plate has been proposed as a new technique. The aim of the study was to investigate the effect of the application of a lag screw on the stability and strength of first metatarsophalangeal joint arthrodesis with medial plate. Methods: The bending tests in a testing machine were performed for models of the first metatarsal bone and the proximal phalanx printed on a 3D printer from polylactide material. The bones were joined using the locking titanium plate and six locking screws. The specimens were divided into three groups of seven each: medial plate and no lag screw, medial plate with a lag screw, dorsal plate with a lag screw. The tests were carried out quasi-static until the samples failure. Results: The addition of the lag screw to the medial plate significantly increased flexural stiffness (41.45 N/mm vs 23.84 N/mm, p = 0.002), which was lower than that of the dorsal plate with a lag screw (81.29 N/mm, p < 0.001). The similar maximum force greater than 700 N (p > 0.50) and the relative bone displacements lower than 0.5 mm for a force of 50 N were obtained for all fixation techniques. Conclusions: The lag screw significantly increased the shear stiffness in particular and reduced relative transverse displacements to the level that should not delay the healing process for the full load of the MTP-1 joint arthrodesis with the medial plate. It is recommended to use the locking screws with a larger cross-sectional area of the head to minimize rotation of the medial plate relative to the metatarsal bone.

Medially positioned plate in first metatarsophalangeal joint arthrodesis.

OBJECTIVE: The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates. METHODS: A physical model of the MTP1 joint consists of printed synthetic bones, a titanium locking plate and screws. In the experiments, samples with dorsally and medially positioned plates were subjected to loading of ground load character in a universal testing machine. Force-displacement relations and relative displacements of bones were recorded. The obtained results were used to validate the corresponding finite element models of the MTP1 joint. Nonlinear finite element simulations of the toe-off phase of gait were performed to determine the deformation and stress state in the MTP1 joint for two positions of the plate. RESULTS: In numerical simulations, the maximum displacement in the dorsal direction was noticed at the tip of the distal phalanx and was equal to 19.6 mm for the dorsal plate and 9.63 mm for the medial plate for a resultant force of 150 N. Lower relative bone displacements and smaller plastic deformation in the plate were observed in the model with the medial plate. Stress values were also smaller in the medially positioned plate and locking screws compared to fixation with the dorsal plate. CONCLUSIONS: A medially positioned locking plate provides better stability of the MTP1 joint than a dorsally positioned plate due to greater vertical bending stiffness of the medial plate. Smaller relative bone displacements observed in fixation with the medial plate may be beneficial for the bone healing process. Moreover, lower stress values may decrease the risk of complications associated with hardware failure.

One Year Evaluation of Material Properties Changes of Polylactide Parts in Various Hydrolytic Degradation Conditions.

Biodegradable biocompatible materials are widely used in medical applications. Determining the possibility of using biodegradable materials depends on determining the changes in their parameters over time due to degradation. The current scientific research on biodegradable materials has presented results based on research methods characterized by the different geometry and cross-section size of the specimen, type of degradation medium, or different pH value of the medium or maximum degradation time. This paper presents the results of a one-year study on the influence of the type of degradation medium on the changes in mechanical behavior and the uptake of the degradation medium by biodegradable specimens with large cross-sections. In addition, a prototype of a test stand was created, which allowed for the specimens to be stored vertically to ensure regular medium exposure and eliminate the interaction of the surface of the tested specimens with the sides of the container. The obtained results allowed the statistical significance of differences in the mechanical parameters determined in the uniaxial tensile test after 2, 4, 6, 12, 26, 39, and 52 weeks of degradation to be indicated depending on the type of degradation medium. It was proven that the changes in mechanical behavior depend on the percentage change in the mass of the specimens during degradation. The percentage change in mass depends on the type of degradation medium. Based on the results of this research, it was noted that in long-term degradation above 12 weeks, buffered sodium chloride solution is the optimal choice for the degradation medium. However, distilled water or physiological saline solution can be used as an alternative during the degradation period for up to 12 weeks.

Biomechanical properties of 3D-printed bone models.

Bone lesions resulting from large traumas or cancer resections can be successfully treated by directly using synthetic materials or in combination with tissue engineering methods (hybrid). Synthetic or hybrid materials combined with bone tissue's natural ability for regeneration and biological adaptation to the directions of loading, allow for full recovery of its biological functions. Increasing interest in new production methods or various types of regenerative membranes and shaped scaffolds means that methods such as additive manufacturing can significantly accelerate the preparation of constructs used in the further biological adaptation of natural tissue. The porosity that allows not only ingrowth of the natural tissue, but also the ability of the synthetic material to transfer loadings in the skeletal system during the regeneration interval, will have a significant impact on regenerative capacities. This work presents the results of preliminary analyzes of bone models in the field of mechanical strength for monotonically and cyclically loading conditions. The determined material constants, such as ultimate tensile strength, Young modulus, and toughness or fatigue life, can be used in numerical simulations of new membranes for the regeneration of damaged bone tissue.