Journal of Foot and Ankle Surgery
Volume 49, Issue 3 , Pages 248-252 , May 2010

Comparison of Pullout Strength between 3.5-mm Fully Threaded, Bicortical Screws and 4.0-mm Partially Threaded, Cancellous Screws in the Fixation of Medial Malleolar Fractures

  • Jason D. Pollard, DPM

      Affiliations

    • Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopaedics and Podiatry, Kaiser Foundation Hospital, Oakland, CA
    • Corresponding Author InformationAddress correspondence to: Jason D. Pollard, DPM, Department of Orthopaedics and Podiatry, Kaiser Foundation Hospital, 901 Nevin Avenue, Richmond, CA 94801.
    • ,
  • Ali Deyhim, DPM

      Affiliations

    • Chief Resident, Third-Year Surgical Residency, Oakwood Annapolis Hospital, Wayne, MI
    • ,
  • Ryan B. Rigby, DPM

      Affiliations

    • Chief Resident, Second Year Surgical Residency, Oakwood Annapolis Hospital, Wayne, MI
    • ,
  • Nathan Dau, MSE

      Affiliations

    • Research Assistant, Department of Biomedical Engineering, Wayne State University, Detroit, MI
    • ,
  • Christy King, DPM

      Affiliations

    • First-Year Surgical Resident, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, CA
    • ,
  • Lawrence M. Fallat, DPM, FACFAS

      Affiliations

    • Diplomat, American Board of Podiatric Surgery; Director, Podiatric Surgical Residency, Oakwood Annapolis Hospital, Wayne, MI
    • ,
  • Cynthia Bir, PhD

      Affiliations

    • Professor, Department of Biomedical Engineering, Director of Research, Orthopaedic Surgery, Wayne State University, Detroit, MI

References 

  1. Herscovici D, Scaduto JM, Infante A. Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg Br. 2007;89(1):89–93
  2. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970–2000 and projections for the future. Bone. 2002;31:430–433
  3. Koval KJ, Zhou W, Sparks MJ, Cantu RV, Hecht P, Lurie J. Complications after ankle fracture in elderly patients. Foot Ankle Int. 2007;28(12):1249–1255
  4. Valtola A, Honkanen R, Kroger H, Tuppurainen M, Saarikoski S, Alhava E. Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study. Bone. 2002;30(1):238–242
  5. Beauchamp CG, Clay NR, Thexton PW. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br. 1983;65(3):329–332
  6. Salai M, Dudkiewicz I, Novikov I, Amit Y, Chechick A. The epidemic of ankle fractures in the elderly—is surgical treatment warranted?. Arch Orthop Trauma Surg. 2000;120(9):511–513
  7. Srinivasan CM, Moran CG. Internal fixation of ankle fractures in the very elderly. Injury. 2001;32(7):559–563
  8. Chapman JR, Harrington RM, Lee KM, Anderson PA, Tencer AF, Kowalski D. Factors affecting the pullout strength of cancellous bone screws. J Biomech Eng. 1996;118(3):391–398
  9. Collinge CA, Stern S, Cordes S, Lautenschlager EP. Mechanical properties of small fragment screws. Clin Orthop Relat Res. 2000;373:277–284
  10. Zhang QH, Tan SH, Chou SM. Investigation of fixation screw pull-out strength on human spine. J Biomech. 2004;37(4):479–485
  11. Cordey J, Schneider M, Belendez C, Ziegler WJ, Rahn BA, Perren SM. Effect of bone size, not density, on the stiffness. J Bone Miner Res. 1992;7(Suppl 2):s437–s444
  12. Gatti D, Sartori E, Braga V, Corallo F, Rossini M, Adami S. Radial bending breaking resistance derived by the densitometric evaluation predicts femoral neck fracture. Osteoporosis Int. 2001;12:864–869
  13. Johnson BA, Fallat LM. Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures. J Foot Ankle Surg. 1997;36(4):284–289
  14. Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg. 1976;58A:356–357
  15. Schatzker J, Albo A, Sheehan J. Screws and plates and their application. In:  Allgower M editors. Manual of Internal Fixation. New York: Springer Verlag; 1991;p. 179–290
  16. Jennings MM, Schuberth JM. Fixation of the medial malleolar fracture: a simplified technique. J Foot Ankle Surg. 2008;47(4):368–371
  17. Koslowsky TC, Mader K, Kirchner S, Gausepohl T, Pennig D. Treatment of medial malleolar fractures using fine-threaded K-wires: a new operative technique. J Trauma. 2007;62(1):258–261
  18. Rovinsky D, Haskell A, Liu Q, Paiement GD, Robinovitch S. Evaluation of a new method of small fragment fixation in a medial malleolus fracture model. J Orthop Trauma. 2000;14(6):420–425
  19. Geogiadis GM, White DB. Modified tension band wiring of medial malleolar ankle fractures. Foot Ankle Int. 1995;16(2):64–68
  20. Kupcha P, Pappas S. Medial malleolar fixation with a bicortical screw: technique tip. Foot Ankle Int. 2008;29(11):1151–115
  21. Asnis SE, Ernberg JJ, Bostrom MP, Wright TM, Harrington RM, Tencer A, et al. Cancellous bone screw thread design and holding power. J Orthop Trauma. 1996;10(7):462–469
  22. Mueller M, Abel EW. Pull-out strengths for a range of screw inserted into the calcaneus: a preliminary study. Clin Biomech. 1992;7(2):125–128
  23. DeCoster TA, Heetderks DB, Downey DJ, Ferries JS, Jones W. Optimizing bone screw pullout force. J Orthop Trauma. 1990;4(2):169–174
  24. Gausepohl T, Mohring R, Pennig D, Koebke J. Fine thread versus coarse thread. A comparison of the maximum holding power. Injury. 2001;32(suppl 4):SD1–7
  25. Thompson JD, Benjamin JB, Szivek JA. Pullout strengths of cannulated and noncannulated cancellous bone screws. Clin Orthop Relat Res. 1997;341:241–249
  26. Khalid M, Theivendran K, Cheema M, Rajaratnam V, Deshmukh SC. Biomechanical comparison of pull-out force of unicortical versus bicortical screws in proximal phalanges of the hand: a human cadaveric study. Clin Biomech (Bristol, Avon). 2008;23(9):1136–1140
  27. Leggon R, Lindsey RW, Doherty BJ, Alexander J, Noble P. The holding strength of cannulated screws compared with solid core screws in cortical and cancellous bone. J Orthop Trauma. 1993;7(5):450–457
  28. Hearn TC, Schatzker J, Wolfson N. Extraction of cannulated screws. Clin Orthop Relat Res. 1993;341:241–249
  29. Kissel CG, Friedersdorf SC, Foltz DS, Snoeyink T. Comparison of pullout strength of small-diameter cannulated and sold-core screws. J Foot Ankle Surg. 2003;42(6):334–338
  30. Ronderos JF, Jacobowitz R, Sonntag VK, Crawford NR, Dickman CA. Comparative pull-out strength of tapped and untapped pilot holes for bicortical anterior cervical screws. Spine. 1997;22(2):167–170
  31. Murphy TP, Hill CM, Kapatkin AS, Radin A, Shofer FS, Smith GK. Pullout properties of 3.5 mm AO/ASIF self tapping and cortex screws in a uniform synthetic material and in canine bone. Vet Surg. 2001;30(3):253–260
  32. Strauss EJ, Egol KA. The management of ankle fractures in the elderly. Injury. 2007;38(Suppl 3):S2–9
  33. Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am. 2003;85-A(5):820–824
  34. Ali MS, McLaren CA, Rouholamin E, O'Connor BT. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma. 1987;1(4):275–280
  35. Makwana NK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomized study. J Bone Joint Surg Br. 2001;83(4):525–529

 Financial Disclosure: None reported.

 Conflict of Interest: None reported.

PII: S1067-2516(10)00046-3

doi: 10.1053/j.jfas.2010.02.006

Journal of Foot and Ankle Surgery
Volume 49, Issue 3 , Pages 248-252 , May 2010

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