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  • Title: Evaluation of a new method of small fragment fixation in a medial malleolus fracture model.
    Author: Rovinsky D, Haskell A, Liu Q, Paiement GD, Robinovitch S.
    Journal: J Orthop Trauma; 2000 Aug; 14(6):420-5. PubMed ID: 11001416.
    Abstract:
    OBJECTIVE: To evaluate a new method of small fragment fixation in a medial malleolus fracture model. DESIGN/METHODS: The authors measured the pullout strength, resistance to shear stress, and speed of insertion of 4.0-millimeter partially threaded cancellous screws, 2.4-millimeter smooth K-wires, and a small fragment fixation system with 2.2-millimeter threaded K-wires. Pullout strength was tested in eighty-one synthetic foam blocks and resistance to shear stress in thirty synthetic tibias by use of a servohydraulic testing machine. Six randomized time trials with the threaded K-wires and cancellous screws were also conducted. RESULTS: Pullout strength increased with increasing foam density, increasing insertion depth, and varied with fixation method (p < 0.05). Maximum pullout strengths were as follows: partially threaded cancellous screws, 730+/-4 Newtons; threaded K-wires, 316+/-12 Newtons; and smooth K-wires, 172 +/-5 Newtons. Percent difference in pullout strength between the partially threaded cancellous screw and threaded K-wire diminished with increased depth of insertion and increased foam density. Offset axial load to initiate fracture displacement in a synthetic tibia model averaged 1540+/-138 Newtons for the partially threaded cancellous screws, 1,318+/-117 Newtons for the threaded K-wires, and 1,287+/-121 Newtons for the smooth K-wires (p > 0.05). Average time of fixation of a medial malleolar fragment by orthopedic surgeons with a variety of experience levels in a synthetic tibia with two threaded K-wires (114+/-8 seconds) was significantly faster (p < 0.05) than with two partially threaded cancellous screws (207+/-20 seconds). CONCLUSIONS: Threaded K-wires show substantial pullout strength and similar resistance to offset axial load when compared with partially threaded cancellous screws. These threaded K-wires offer an alternative for the internal fixation of medial malleolus fractures.
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