The Effect of Screw Design and Cortical Augmentation on Insertional Torque and Compression in Coracoid-Glenoid Fixation in a Sawbones Model

Rabinowitz, Justin; Lin, Jackie; Greenhouse, Alyssa; Rao, Meghana V.; Provencher, Matthew T.; Parada, Stephen A.; Friedman, Richard J.; Eichinger, Josef K.

doi:10.1016/j.arthro.2019.10.011

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…Cadaveric models were used in 8 of the included studies, 1,27,29,36,41,48,53,55 and synthetic materials were used in 5 of the studies. 4,19,40,45,54 A summary of the biomechanical findings of each study is shown in Appendix Table A1.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 2 such studies have sought to examine these variables. Rabinowitz et al 40 demonstrated that the use of two 3.5-mm partially threaded titanium cannulated screws with top hats or two 3.75-mm fully threaded titanium cannulated screws with a 2-hole wedged-profile plate resulted in a higher mean insertional torque at failure versus two 3.75-mm fully threaded titanium cannulated screws or two 4.0-mm partially threaded stainless steel cannulated screws without cortical augmentation (Appendix Table A1). However, screws with top hats or plates failed by coracoid fracture (50% and 90%, respectively) more so than screws without augmentation (5%).…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

Manfredi,

Schick,

Paul

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Glenohumeral dislocations often lead to glenoid bone loss and recurrent instability, warranting bony augmentation. While numerous biomechanical studies have investigated fixation methods to secure a graft to the glenoid, a review of available constructs has yet to be performed. Purpose: To synthesize the literature and compare the biomechanics of screw and suture button constructs for anterior glenoid bony augmentation. Study Design: Systematic review. Methods: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 2 independent reviewers who performed a literature search using the PubMed, Embase, and Google Scholar databases of studies published between 1950 and 2020. Studies were included that compared the biomechanical outcomes of fixation for the treatment of anterior shoulder instability with glenoid bone loss. Results: Overall, 13 of the 363 studies screened met the inclusion criteria. The included studies measured the biomechanical strength of screws or suture buttons on a cadaveric or synthetic Latarjet construct. Screws and suture buttons were biomechanically similar, as both constructs exhibited comparable loads at failure and final displacement. Screw type (diameter, threading, or composition) did not significantly affect construct strength, and double-screw fixation was superior to single-screw fixation. Additionally, 2 screws augmented with a small plate had a higher load at failure than screws that were not augmented. Unicortical double-screw fixation was inferior to bicortical double-screw fixation, although construct strength did not significantly decrease if 1 of these screws was unicortical. Further, 2 screws inserted at 15° off axis experienced significantly higher graft displacement and lower ultimate failure loads than those inserted at 0° parallel to the glenoid. Conclusion: Suture buttons provided comparable strength to screws and offer an effective alternative to reduce screw-related complications. Augmentation with a small plate may clinically enhance construct strength and decrease complications through the dispersion of force loads over a greater surface area. Differences in screw type did not appear to alter construct strength, provided that screws were placed parallel to the articular surface and were bicortical.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

Manfredi,

Schick,

Paul

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…The effect of cortical augmentation as well as screw design has been studied previously in a foam block model simulating the Latarjet procedure. Rabinowitz et al 15 examined a Latarjet model with fixation consisting of either 3.5-mm partially threaded titanium cannulated screws with “top hats,” 3.75-mm fully threaded titanium cannulated screws with a 2-hole wedged profile plate, 3.75-mm fully threaded titanium cannulated screws without a 2-hole wedged profile plate, or 4.0-mm partially threaded stainless steel cannulated screws. They found that the cortically augmented fixation methods (top hat and wedged plate) demonstrated a higher maximum insertion torque, maximum contact pressure, and effective pressure distribution between the surfaces of their coracoid and glenoid models when utilizing polyurethane blocks.…”

Section: Discussionmentioning

confidence: 99%

Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Parada

Shaw

McGee‐Lawrence

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Glenoid reconstruction with distal tibial allograft (DTA) is a known surgical option for treating recurrent glenohumeral instability with anterior glenoid bone loss; however, biomechanical analysis has yet to determine how graft variability and fixation options alter the torque of screw insertion and load to failure. Hypothesis: It was hypothesized that retention of the lateral cortex of the DTA graft and the presence of a washer with the screw will significantly increase the maximum screw placement torque as well as the load to failure. Study Design: Controlled laboratory study. Methods: Whole, fresh distal tibias were used to harvest 28 DTA grafts, half of which had the lateral cortex removed and half of which had the lateral cortex intact. The grafts were secured to polyurethane solid foam blocks with a 2-mm epoxy laminate to simulate a glenoid with an intact posterior glenoid cortex. Grafts underwent fixation with 4.0-mm cannulated drills, and screws and washers were used for half of each group of grafts while screws alone were used for the other half, creating 4 equal groups of 7 samples each. A digital torque-measuring screwdriver recorded peak torque for screw insertion. Constructs were then tested in compression with a uniaxial materials testing system and loaded in displacement control at 100 mm/min until at least 3 mm of displacement occurred. Ultimate load was defined as the load sustained at clinical failure. Results: The use of a washer significantly improved the ultimate torque that could be applied to the screws (+cortex and +washer = 12.42 N·m [SE, 0.82]; –cortex and +washer = 10.54 N·m [SE, 0.59]) ( P < .0001), whereas the presence of the native bone cortex did not have a significant effect (+cortex and –washer = 7.83 N·m [SE, 0.40]; –cortex and –washer = 8.03 N·m [SE, 0.56]) ( P = .181). Conclusion: In a hybrid construct of fresh cadaveric DTA grafts secured to a foam block glenoid model, the addition of washers was more effective than the retention of the lateral distal tibial cortex for both load to failure and peak torque during screw insertion. Clinical Relevance: This biomechanical study is relevant to the surgeon when choosing a graft and selecting fixation options during glenoid reconstruction with a DTA graft.

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“…The entry point of the K-wire through the high anteromedial portal might result in a screw trajectory not completely perpendicular to the fracture line. 10 However, it spares the creation of a Nevasier portal, thus minimizing the risk of suprascapular nerve lesion or of penetration of the supraspinatus tendon. 8 The arthroscopic procedure substantially diminishes the extensive soft-tissue trauma as compared with open surgery, thus reducing the risk of potential complications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arthroscopic Screw Fixation Technique for Transverse Glenoid Fractures

Wafaisade

Kappel

Pfeiffer

et al. 2021

Arthroscopy Techniques

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Transverse glenoid fractures with a cranial coracoglenoidal fragment (Ideberg type III) can lead to detrimental post-traumatic sequelae. Open surgery requires an extensive surgical approach. Arthroscopic procedures are highly challenging with respect to both fracture reduction and screw osteosynthesis. We present a reproducible arthroscopic technique for a dislocated transverse glenoid fracture using 5 standard portals. Grasping the coracoid with a small, serrated reduction clamp through the anterior portal allows simple and sufficient reduction. Safe screw osteosynthesis can then be performed from cranially without the need to create a Neviaser portal.

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The Effect of Screw Design and Cortical Augmentation on Insertional Torque and Compression in Coracoid-Glenoid Fixation in a Sawbones Model

Cited by 6 publications

References 31 publications

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Arthroscopic Screw Fixation Technique for Transverse Glenoid Fractures

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