Korean J Sports Med.  2014 Dec;32(2):79-84. 10.5763/kjsm.2014.32.2.79.

A Comparison of Bicortical and Intramedullary Screw Fixations in Jones' Fractures Using Finite Element Analysis: Preliminary Report

• Lee YS
• Lee JY
• Park SS
• Lim CW
• Kwon EJ

• KMID: 2288662
• DOI: http://doi.org/10.5763/kjsm.2014.32.2.79

Abstract

Intramedullary screw fixation and bicortical screw fixation are widely used operation methods in the surgical treatment of Jones fractures. The purpose of this study is to evaluate of mechnical stability in two kind of Jones fracture. Using Mimics, three-dimensional models of the fifth metatarsal were reconstructed form computed tomography images of a 23-year-old Korean healthy male. Normal and osteoporotic bone models were made by changing bone density or thickness of cortical and cancellous bone. Two kinds of fixation techniques, i.e., intramedullary and bicortical screw fixation models, were simulated and muscles forces related to the fifth metatarsal base were applied. Maximum contact pressure difference were measured as 20,818 MPa, 12,155 MPa in normal bone, 23,371 MPa, 13,765 MPa in 85% cancellous osteoporotic bone, 24,310 MPa and 14,264 MPa in 75% cancellos osteoporotic model, 21,337 MPa, 20,971 MPa in -0.5 mm cortical osteoporotic bone, 26,322 MPa and 36,153 MPa in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Displacements on fracture interface were 0.208 mm, 0.126 mm in normal bone while 0.229 mm, 0.127 mm in 85% cancellos osteoporotic model, 0.241 mm, 0.127 mm in 75% cancellos osteoporotic model, 0.223 mm, 0.271 mm in -0.5 mm cortical osteoporotic model, 0.292 mm, 0.480 mm in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Bicortical screw fixation is superior in mechanical stability than intramedullary screw fixation for normal bone quality Jones fractures. For cortical osteoporotic bone Jones fractures, however, intramedullary screw fixation can give a better mechanical stability than bicortical screw fixation.

Keyword

Metatarsal bones; Fracture fixation; Finite element analysis

MeSH Terms

Bone Density
Finite Element Analysis*
Fracture Fixation
Humans
Male
Metatarsal Bones
Muscles
Young Adult

Figure

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  Fig. 1. Bicortical screw fixation (A), Intramedullary screw fixation (B) model. Rectangular grid is fracture plane.

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  Fig. 2. Boundary condition. Interface between cortical and cancellous bone is bonded. Bonded: no movement, complete union state, Fracture site: interface between screw and bone are no separation, No separation: movement can occur but contact is maintained, Fixed support: fifth meta-tarsophalangeal joint is fixed state.

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  Fig. 3. Contact pressure on fracture plane. Contact pressure distribution is displayed by gradation scale. (A) is displayed by similar color. But, (B) is displayed by various color (sharp contrast). In other words, (A) is more evenly distributed contact pressure and (B) is too concentrated or too little contact pressure. It means mechanical stable or unstable, respectively.

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