TY  - JOUR
A1  - Fuchs, Konrad F.
A1  - Heilig, Philipp
A1  - McDonogh, Miriam
A1  - Boelch, Sebastian
A1  - Gbureck, Uwe
A1  - Meffert, Rainer H.
A1  - Hoelscher-Doht, Stefanie
A1  - Jordan, Martin C.
T1  - Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes
T2  - Journal of Orthopaedic Surgery and Research
N2  - Background 
The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. 

Methods 
A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys (R) QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem (TM) V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. 

Results 
The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. 

Conclusion 
Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.
KW  - arthritis
KW  - bone
KW  - calcaneus
KW  - cement
KW  - fracture
KW  - fixation
KW  - osteoporosis
KW  - sanders
KW  - screw
Y1  - 2020
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/23033
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-230336
VL  - 15
ER  -