Abstract
This study aimed to evaluate different fixation techniques and implants in oblique
and biplanar chevron medial malleolar osteotomies using finite element analysis. Both
oblique and biplanar chevron osteotomy models were created, and each osteotomy was
fixed with 2 different screws (3.5 mm cortical screw and 4.0 mm malleolar screw) in
2 different configurations; (1) 2 perpendicular screws, and (2) an additional third
transverse screw. Nine simulation scenarios were set up, including 8 osteotomy fixations
and the intact ankle. A bodyweight of 810.44 N vertical loading was applied to simulate
a single leg stand on a fixed ankle. Sliding, separation, frictional stress, contact
pressures between the fragments were analyzed. Maximum sliding (58.347µm) was seen
in oblique osteotomy fixed with 2 malleolar screws, and the minimum sliding (17.272
µm) was seen in chevron osteotomy fixed with 3 cortical screws. The maximum separation
was seen in chevron osteotomy fixed with 2 malleolar screws, and the minimum separation
was seen in oblique osteotomy fixed with 3 cortical screws. Maximum contact pressure
and the frictional stress at the osteotomy plane were obtained in chevron osteotomy
fixed with 3 cortical screws. The closest value to normal tibiotalar contact pressures
was obtained in chevron osteotomy fixed with 3 cortical screws. This study revealed
that cortical screws provided better stability compared to malleolar screws in each
tested osteotomy and fixation configuration. The insertion of the third transverse
screw decreased both sliding and separation. Biplanar chevron osteotomy fixed with
3 cortical screws was the most stable model.
Level of Clinical Evidence
Keywords
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Published online: July 22, 2021
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