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 CME 4: October, November, December 2003
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The Journal of Bone and Joint Surgery (American) 85:2425-2428 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Intramedullary Rod Fixation Compared with Blade-Plate-and-Screw Fixation for Tibiotalocalcaneal Arthrodesis: A Biomechanical Investigation

Christopher P. Chiodo, MD1, Jorge I. Acevedo, MD1, V. James Sammarco, MD1, Brent G. Parks, MSC1, Henry R. Boucher, MD1, Mark S. Myerson, MD1 and Lew C. Schon, MD1

1 Department of Orthopaedic Surgery, Union Memorial Hospital, c/o Lyn Camire, Editor, Union Memorial Orthopaedics, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218. E-mail address for L.C. Schon: lyn.camire{at}medstar.net

Investigation performed at the Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Achieving stable fixation when performing tibiotalocalcaneal arthrodesis can be challenging, especially in osteopenic bone. The purpose of the current investigation was to compare the stiffness and fatigue endurance of blade-plate-and-screw fixation with intramedullary rod fixation in a cadaveric model.

Methods: In ten matched pairs of fresh-frozen cadaveric legs, a tibiotalocalcaneal arthrodesis was performed with use of a blade-plate and a 6.5-mm sagittal screw in one leg and with use of an intramedullary rod in the contralateral leg. After an initial load-deformation curve was obtained, each specimen was loaded to 270 N through 250,000 cycles at a rate of 3 Hz.

Results: Blade-plate-and-screw fixation resulted in significantly higher mean initial and final stiffness and decreased plastic deformation than did intramedullary rod fixation. In addition, there was an inverse correlation between bone-mineral density and the difference in plastic deformation noted between the specimens of each pair.

Conclusions: Blade-plate fixation is biomechanically superior to intramedullary fixation for tibiotalocalcaneal arthrodesis.

Clinical Relevance: Although good fixation can be achieved with an intramedullary rod or a blade-plate-and-screw construct, the stability of the blade-plate-and-screw construct may have advantages, particularly in osteopenic bone.


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Letters to the Editor:

Read all Letters to the Editor

Intra-Medullary Rod versus Blade-Plate and Screw Fixation for Tibiotalocalcaneal Arthrodesis
Stuart D. Miller, M.D.
JBJS Online, 10 Feb 2004 [Full text]
Dr. Schon responds:
Lew C Schon, et al.
JBJS Online, 10 Feb 2004 [Full text]
Intaramedullary Rod versus Blade Plate Fixation for Tibiotalocalcaneal Arthrodesis
Konrad Mader, et al.
JBJS Online, 14 Jun 2004 [Full text]
Dr. Schon responds to Dr. Mader, et al.
Lew C. Schon, M.D., et al.
JBJS Online, 14 Jun 2004 [Full text]