An in Vivo Experimental Comparison of Stainless Steel and Titanium Schanz Screws for External Fixation

Ganser, A.; Thompson, R. E.; Tami, Ivan; Neuhoff, D; Steiner, Adrian; Ito, Keita

doi:10.1007/s00068-007-6053-5

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…On day 14, visible clinical findings at each pin site were classified according to pin site infection criteria as no infection, inflammation or serous drainage without frank purulence, or frank purulence. 26,27 Clinical determination of infection was defined as all three observers being in agreement. After evaluation by eye, the animals were sacrificed and the bone and soft tissue around the pin were retrieved.…”

Section: Evaluation Of Bactericidal Effectmentioning

confidence: 99%

Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins

Koseki¹,

Asahara²,

Shida³

et al. 2013

IJN

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Background:Pin site infection is the most common and significant complication of external fixation. In this work, the efficacy of pins coated with titanium dioxide (TiO 2 ) for inhibition of infection was compared with that of stainless steel control pins in an in vivo study. Methods: Pins contaminated with an identifiable Staphylococcus aureus strain were inserted into femoral bone in a rat model and exposed to ultraviolet A light for 30 minutes. On day 14, the animals were sacrificed and the bone and soft tissue around the pin were retrieved. The clinical findings and histological findings were evaluated in 60 samples. Results: Clinical signs of infection were present in 76.7% of untreated pins, but in only 36.7% of TiO 2 -coated pins. The histological bone infection score and planimetric rate of occupation for bacterial colonies and neutrophils in the TiO 2 -coated pin group were lower than those in the control group. The bone-implant contact ratio of the TiO 2 -coated pin group was significantly higher (71.4%) than in the control pin group (58.2%). The TiO 2 was successful in decreasing infection both clinically and histomorphometrically. Conclusion:The photocatalytic bactericidal effect of TiO 2 is thought to be useful for inhibiting pin site infection after external fixation.

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Section: Evaluation Of Bactericidal Effectmentioning

confidence: 99%

Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins

Koseki¹,

Asahara²,

Shida³

et al. 2013

IJN

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“…This difference may be due, in part, to the cyclic loading by the animal which may delay or partly inhibit the formation and maintenance of bony on-growth. 5 This study was designed to evaluate the removal of intramedullary nail interlocking screws following a nonunion in a canine model. Based on Ganser et al, 5 it was hypothesized that explantation torques would be greater than the intraoperative insertional torque for the screws adjacent to the fracture.…”

Section: Introductionmentioning

confidence: 99%

“…5 This study was designed to evaluate the removal of intramedullary nail interlocking screws following a nonunion in a canine model. Based on Ganser et al, 5 it was hypothesized that explantation torques would be greater than the intraoperative insertional torque for the screws adjacent to the fracture. The limbs were analyzed in two groups: unloaded and loaded to failure in torsion prior to screw removal.…”

Section: Introductionmentioning

confidence: 99%

Removal torque of nail interlocking screws is related to screw proximity to the fracture and screw breakage

White

Kubacki

Samona

et al. 2016

Proc Inst Mech Eng H

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Studies have shown that titanium implants can be challenging to explant due to the material's excellent biocompatibility and resulting osseointegration. Clinically, titanium alloy nail interlocking screws may require removal to dynamize a construct or revise the nail due to nonunion, infection, pain, or periprosthetic fracture. This study was designed to determine what variables influence the removal torque for titanium alloy interlocking screws. An intramedullary nail with four interlocking screws was used to stabilize a 1-cm segmental femoral defect in a canine model for 16 weeks. The animals were observed to be active following a several-day recovery after surgery. In six animals, the femora and implanted nail/screws were first tested to failure in torsion to simulate periprosthetic fracture of an implant after which the screws were then removed. In four additional animals, the screws were removed without mechanical testing. Both intraoperative insertional and extraction torques were recorded for all screws. Mechanical testing to failure broke 10/24 screws. On average, the intact screws required 70% of the insertional torque during removal while broken screws only required 16% of the insertional torque (p < 0.001). In addition, intact screws closer to the fracture required 2.8 times more removal torque than the outboard distal screw (p < 0.005). On average, the angle of rotation to peak torque was ∼80°. The peak axial load did not significantly correlate with the torque required to remove the screws. On average, the removal torque was lower than at the time of insertion, and less torque was required to remove broken screws and screws remote to the fracture. However, broken screws will require additional time to retrieve the remaining screw fragment. This study suggests that broken screws and screws in prematurely active patients will require less torque to remove.

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“…[4][5][6] , and titanium is now used as a dental implant material 7) . Ganser et al 8) reported the clinical benefits of stainless steel and titanium for reducing pin track irritation/infection and pin loosening during external fracture fixation of the hind limbs of sheep, and found no clinically relevant substantial advantage in using either stainless steel or titanium pins. Choi et al 9) performed a clinical comparative study between titanium and stainless steel for microsurgical cerebral aneurysm clip implants.…”

Section: Introductionmentioning

confidence: 99%

Stainless and Titanium Fibers as Non-degradable Three-dimensional Scaffolds for Bone Reconstruction

Yasuoka

Usukura

Fusé

et al. 2014

J. Hard Tissue Biology.

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Stainless steel is used for various medical devices. Titanium is also widely used because of its tight bonding to bone tissue, namely osseointegration. The aim of the present study was to investigate the efficacy of three-dimensional stainless steel and titanium porous structure scaffolds by in vitro and in vivo experiments. Stainless steel and titanium fiber materials were designed as non-degradable metallic three-dimensional scaffolds with a three-dimensional porous structure for bone reconstruction. In one in vitro experiment, stainless steel and titanium disks were immersed in simulated body fluid. After immersion, a greater amount of hydroxyapatite precipitation was observed on titanium disks than on stainless steel disks. The crystallographic structure of precipitated hydroxyapatite was confirmed by the measurement of X-ray diffraction patterns. In another in vitro study, the adsorption behavior of fibronectin to stainless steel and titanium was monitored by the quartz crystal microbalance (QCM) method, which demonstrated more fibronectin adsorption onto titanium than onto stainless steel. In an in vivo experiment, three-dimensional stainless steel or titanium fibers were implanted into the cortical bone of the tibia of rabbits. Histological and histomorphometrical evaluation revealed a significantly greater amount of bone formation inside the porous area of the titanium fibers after 4 weeks of implantation. The present study also revealed better osteoconductivity of titanium than stainless steel. It is presumed that this was due to the differences in the characteristics of passive film between titanium and stainless steel. Titanium fibers are expected to be useful as a non-resorbable three-dimensional scaffold in bone reconstruction.

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An in Vivo Experimental Comparison of Stainless Steel and Titanium Schanz Screws for External Fixation

Abstract: There is no clinically relevant substantial advantage in using either SS or Ti pins on reducing pin loosening or pin track irritation/infection.

Cited by 10 publications

References 17 publications

Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins

Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins

Removal torque of nail interlocking screws is related to screw proximity to the fracture and screw breakage

Stainless and Titanium Fibers as Non-degradable Three-dimensional Scaffolds for Bone Reconstruction

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