Surgeon Perception of Cancellous Screw Fixation

Stoesz, Michael J.; Gustafson, Peter A.; Patel, Bipinchandra; Jastifer, James R.; Chess, Joseph L.

doi:10.1097/bot.0b013e31829ef63b

Cited by 34 publications

(18 citation statements)

References 33 publications

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“…[16][17][18] Furthermore, ASTM supports the use of rigid polyurethane foam as an ideal testing analogue for human cancellous bone, 12 and similar published studies evaluating screw design biomechanics use polyurethane foam as their testing material. 4,5,9,11 Ricci et al 11 evaluated stainless steel screws with varying thread pitches in terms of their maximum insertion torque and pullout strength, using a polyurethane foam model to represent osteoporotic cancellous bone. They found that increased thread pitch allowed increased maximal insertional torque and demonstrated a linear relationship between maximal insertional torque and compressive force under the screw head.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] More recently, maximum insertional torque has been advocated as a means to quantify screw fixation quality; this value is proportional to the amount of compression generated underneath the screw head. [9][10][11] In patients with osteoporotic bone, screw stripping may occur prior to the generation of sufficient torque to stabilize the construct.…”

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confidence: 99%

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Cancellous Screws Are Biomechanically Superior to Cortical Screws in Metaphyseal Bone

Wang¹,

Boone²,

Behn³

et al. 2016

Orthopedics

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Cancellous screws are designed to optimize fixation in metaphyseal bone environments; however, certain clinical situations may require the substitution of cortical screws for use in cancellous bone, such as anatomic constraints, fragment size, or available instrumentation. This study compares the biomechanical properties of commercially available cortical and cancellous screw designs in a synthetic model representing various bone densities. Commercially available, fully threaded, 4.0-mm outer-diameter cortical and cancellous screws were tested in terms of pullout strength and maximum insertion torque in standard-density and osteoporotic cancellous bone models. Pullout strength and maximum insertion torque were both found to be greater for cancellous screws than cortical screws in all synthetic densities tested. The magnitude of difference in pullout strength between cortical and cancellous screws increased with decreasing synthetic bone density. Screw displacement prior to failure and total energy absorbed during pullout strength testing were also significantly greater for cancellous screws in osteoporotic models. Stiffness was greater for cancellous screws in standard and osteoporotic models. Cancellous screws have biomechanical advantages over cortical screws when used in metaphyseal bone, implying the ability to both achieve greater compression and resist displacement at the screw-plate interface. Surgeons should preferentially use cancellous over cortical screws in metaphyseal environments where cortical bone is insufficient for fixation. [Orthopedics.2016; 39(5):e828-e832.].

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cancellous Screws Are Biomechanically Superior to Cortical Screws in Metaphyseal Bone

Wang¹,

Boone²,

Behn³

et al. 2016

Orthopedics

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show abstract

“…3,10,29,35,68 A downside of nonlocking screws is their propensity to strip at the screw-bone interface, which may be eliminated with a locking construct. Stoesz et al 68 showed in a synthetic bone model that up to 45.4% of conventional screws were stripped beyond optimal torque and 90.8% of the time the surgeon did not realize it. Freeman et al 29 showed that a locking screw placed between the fracture site and peripheral nonlocking screws protects the nonlocking screws from loosening and may have some clinical utility in improving fatigue life of the construct.…”

Section: Clinical Considerationsmentioning

confidence: 99%

Topical Review

Jastifer¹

2014

Foot Ankle Int.

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The use of locking plate technology in foot and ankle surgery has increased over the last decade. Reported applications include fracture repair, deformity correction, and arthrodesis. There is limited evidence, however, to guide clinicians with regard to the appropriate and optimal use of this technology. This work aims to examine the current biomechanical and clinical evidence comparing locking construct technology to other forms of fixation in the field of foot and ankle surgery.

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“…The screw thread can lose it purchase strength because of the applied torque surpass the appropriate limit of the bone-screw interface and will turn with little resistance and the risk of screw stripping is approximately 9% and 12 % for overtightened from the insertion on 200 screws in the fixation of ankle fractures in elderly bone [33]. The rate of surgeons identifying the striping when tested with synthetic bone is less than 10% and it is only after the surgeons have significantly exceed the stripping torque [45].…”

Section: Torquementioning

confidence: 99%

Screw-Bone Implant Loosening: Complication, Cause and Assessment

Ghani¹,

Hassan²,

Daud³

2018

IJET

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Bone fracture has become more common in this era of vehicular modernization. Internal fixation has been used in the treatment of such cases. The use of screw and plate in internal fixation has been proven to provide more stability to fracture to promote better healing. The use of screw also carries certain risk such as self-loosening that can cause non-union and prolong healing. The complication of selfloosening is studied to comprehend the danger of self-loosening in screw-bone implant. The review on self-loosening in bolted joint is done in this paper to gain better understanding on the nature of self-loosening phenomena. The factor that affects the screw selfloosening in bone is further studied in the screw-bone implant environment. The identification of the screw loosening can be done with radiography, CT scan, MRI and ultrasound. This article have done a brief review on the complication of screw self-loosening, the cause of screw loosening in bolted joint and screw-bone implant and the assessment of screw loosening done by ultrasound and radiography.

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Surgeon Perception of Cancellous Screw Fixation

Abstract: Surgeon perception is not reliable at preventing and detecting screw stripping at clinical torque levels in synthetic cancellous bone. Less aggressive insertion or standardized methods of insertion may improve the stability of nonlocking screw and plate constructs.

Cited by 34 publications

References 33 publications

Cancellous Screws Are Biomechanically Superior to Cortical Screws in Metaphyseal Bone

Cancellous Screws Are Biomechanically Superior to Cortical Screws in Metaphyseal Bone

Topical Review

Screw-Bone Implant Loosening: Complication, Cause and Assessment

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