Analysis on surgery screw configuration in distal osteotomy MIS surgery
Orthopaedic Surgeon at King's College Hospital NHS Foundation Trust
Its been a very interesting year for our research into minimally invasive surgery particularly when it comes to hallux valgus. Last year we published a finite element analysis study looking at screw configuration in distal osteotomy MIS surgery with Miguel Viana Pereira Filho Roberto Zambelli Gustavo Araujo Nunes Gabriel Ferraz Ferreira (MD, MSc, PhD) Henrique Mansur and Tom Lewis. This paper was highly rated and won the EFAS European Foot & Ankle Society podium prize in 2024 but is was also quite controversial around the discussions about the necessity of 2 screws vs a single screw for metatarsal fixation and the pros and cons of different constructs. Building on this area of scientific research Ryan Geleit Peter Lam Gustavo Araujo NunesGabriel Ferraz Ferreira (MD, MSc, PhD)Tom Lewis and I have recently published a systematic review looking at the body of work on finite element analysis in minimally invasive hallux valgus deformity.
A summary of the paper is as follows:
Research Question/Objective
Primary objective:
To critically evaluate published finite element analysis studies on HV biomechanical characteristics, surgical correction techniques, and fixation methods.
Secondary objectives:
To assess the methodological quality and validation approaches of existing FEA models.
To synthesize biomechanical insights regarding altered mechanical loading in HV.
To compare biomechanical outcomes of different surgical and fixation techniques.
To identify current limitations and suggest directions for future research.
Key Results
Included studies: 19 total (12 surgical FEA studies, 7 biomechanical FEA analyses).
Surgical technique findings:
Metatarsal shortening of up to 6 mm can be tolerated without significantly disturbing foot load distribution.
Beyond 6 mm shortening, pressure ratios exceeding 55% on central rays increase risk of transfer metatarsalgia during push off.
Distal fragment depression of 3 mm can counteract excessive load shifts at up to 8 mm shortening.
Fixation method results:
Dual screw fixation shows superior biomechanical stability compared to single screw or K-wire configurations in minimally invasive HV surgery.
"8"-shaped bandaging alone is insufficient to maintain osteotomy position under physiological loading.
Modeling observations:
Most studies employed static loading conditions and isotropic material properties.
Lack of incorporation of dynamic muscle-tendon forces limits physiological accuracy.
Validation methods varied significantly, hindering direct comparisons.
Finite element analysis and modelling is an exciting way to increase our knowledge but its clear better protols are needed to standardise the science and allow us to make better comparisons!
Please read the full article below and make your own conclusions
https://www.sciencedirect.com/...
A focused biomechanical review sheds light on screw configurations in distal fibular fractures—highlighting how subtle choices in fixation technique can significantly impact stability and outcomes. These findings help guide better-informed surgical decisions in the foot & ankle space.
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