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Mandala M, Shaunak S, Kreitmair P, Phadnis J, Guryel E. Biomechanical comparison of headless compression screws versus independent locking screw for intra-articular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1319-1325. [PMID: 38112781 PMCID: PMC10980631 DOI: 10.1007/s00590-023-03792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Headless compression screws (HCS) have a variable thread pitch and headless design enabling them to embed below the articular surface and generate compression force for fracture healing without restricting movement. Locking screws have greater variety of dimensions and a threaded pitch mirroring the design of the HCS. The objective of this study is to determine whether locking screws can generate compression force and compare the compressive forces generated by HCS versus locking screws. METHOD A comparison between 3.5-mm HCS versus 3.5-mm locking screws and 2.8-mm HCS versus 2.7-mm locking screws was performed using a synthetic foam bone model (Synbone) and FlexiForce sensors to record the compression forces (N). The mean peak compression force was calculated from a sample of 3 screws for each screw type. Statistical analysis was performed using the one-way ANOVA test and statistical significance was determined to be p = < 0.05. RESULTS The 3.5-mm Synthes and Smith and Nephew locking screws generated similar peak compression forces to the 3.5-mm Acutrak 2 headless compression screws with no statistically significant difference between them. The smaller 2.7-mm Synthes and Smith and Nephew locking screws initially generated similar compressive forces up to 1.5 and 2 revolutions, respectively, but their peak compression force was less compared to the 2.8-mm Micro Acutrak 2 HCS. CONCLUSION Locking screws are able to generate compressive forces and may be a viable alternative to headless compressive screws supporting their use for intra-articular fractures.
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Affiliation(s)
| | - Shalin Shaunak
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Joideep Phadnis
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Enis Guryel
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
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2
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Lee E, Jeong HJ, Lee YS, Oh JH. The application of a dual-lead locking screw could enhance the reduction and fixation stability of the proximal humerus fractures: a biomechanical evaluation. Front Surg 2024; 11:1333670. [PMID: 38586241 PMCID: PMC10995320 DOI: 10.3389/fsurg.2024.1333670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Bicortical screw fixation, which penetrates and fixes the near and far cortex of bone, has been conventionally used to achieve compressive fixation for fracture using screws. Open reduction and internal fixation using the locking plate are widely used for treating proximal humerus fractures. However, minimal contact between the bone and the locking plate can lead to an insufficient reduction. Theoretically, a dual-lead locking screw with different leads for the screw head and body could enhance the reduction and fixation stability of fragments in proximal humeral fractures without bicortical fixation, and achieve additional compression at the bone-plate-screw interface. This study assessed the insertion mechanics of the lead ratio of the dual-lead locking screw and its effect on the fixation stability of the proximal humerus fracture. Methods A Multi-Fix® locking plating system composed of ∅ 3.5 mm locking screws and a locking plate was used to make a locked plating for Sawbone bone blocks and fourth-generation composite humeri. Two different types of Sawbone bone blocks were used to simulate the osteoporotic (10 PCF) and normal cancellous (20 PCF) bones. The lead of the screw head thread (L head ) was 0.8 mm, and that of the screw body (L body ) was 0.8, 1.25, 1.6, 2.0, and 2.4 mm, whose lead ratios (R lead = L body / L head ) were 1.0, 1.56, 2.0, 2.5, and 3.0, respectively. Results The dual-lead locking screw elevated the compression between the locking plate and the bone. The elevation in the compression due to the dual-lead thread became weaker for the cancellous bone when the lead of the screw body was more than twice that of the screw head. The plate/humerus compression with strong bone quality withstood higher dual-lead-driven compression. Discussion A dual-lead locking screw of L body = 1.25 mm (R lead = 1.56 ) is recommended for maximum rotational stability for the locked humerus plating. The screws with over L body = 1.6 mm (R lead = 2 ) have no advantage in terms of the failure torque and maximum torsional deformation. Any locking dual-lead screw with a body thread lead of <1.6 mm (R lead = 2 ) can be used without the risk of bone crush when surgeons require additional compression to the locked cancellous bone plating.
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Affiliation(s)
- Eunju Lee
- Department of BioMedical Engineering, School of BioMed Science, Daegu Catholic University, Gyoungbuk, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yeon Soo Lee
- Department of BioMedical Engineering, School of BioMed Science, Daegu Catholic University, Gyoungbuk, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Lynch D, Mickley JP, Gordon A, Roebke AJ, Goyal KS. The Effect of Derotational Kirschner Wires on Fracture Gap Reduction With Variable-Pitch Headless Screws. J Hand Surg Am 2023; 48:86.e1-86.e7. [PMID: 34802813 DOI: 10.1016/j.jhsa.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/06/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the impact of angled derotational Kirschner wires (K-wires) on fracture gap reduction with variable-pitch headless screws. METHODS Fully threaded variable-pitch headless screws (20 and 28 mm) were inserted into "normal" bone models of polyurethane blocks. In separate trials, derotational K-wires were inserted at predetermined angles of 0°, 15°, 30°, and 40° and compared with each other, with no K-wire as a control. Fluoroscopic images taken after each screw turn were analyzed. The optimal fracture gap closure, initial screw push-off, and screw back-out gap creation were determined and compared at various derotational K-wire angles. RESULTS Initial screw push-off due to screw insertion and screw back-out gap creation were not significantly affected by the angle of the derotational K-wire. With a 20-mm screw, only a 40° derotational K-wire led to significantly less gap closure compared with control and with 0°, 15°, and 30° derotational K-wires. It led to an approximately 60% decrease in gap closure compared with no K-wire. With the 28-mm screw, compared with no K-wire, 15° and 30° derotational K-wires led to statistically significant decreases in gap closure (approximately 25%), whereas a 40° derotational K-wire led to an approximately 60% decrease. With the 28-mm screw, the 40° derotational K-wire also led to a statistically significant smaller gap closure when compared with 0°, 15°, and 30° derotational K-wires. CONCLUSIONS A derotational K-wire placed in parallel to the planned trajectory of a headless compression screw does not affect fracture gap closure. With greater angulation of the derotational K-wire, the fracture gap is still closed, but less tightly. CLINICAL RELEVANCE Derotational K-wires can help prevent fracture fragment rotation during headless compression screw insertion. At small deviations from parallel (≤30°), fracture gap closure achieved by the screw is minimally affected. At greater angles (ie, 40°), fracture gap closure may be substantially reduced, preventing fracture compression.
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Affiliation(s)
- Daniel Lynch
- Ohio State University College of Medicine, Columbus, OH
| | | | - Adam Gordon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Fyllos A, Komnos G, Koutis A, Bargiotas K, Varitimidis S, Dailiana Z. Comparison of Minimally Invasive Operative Treatment with Conservative Treatment for Acute, Minimally Displaced Scaphoid Fractures at 12 Months' Follow-up. J Wrist Surg 2021; 10:216-223. [PMID: 34109064 PMCID: PMC8169166 DOI: 10.1055/s-0040-1722333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Background Minimally displaced scaphoid fractures can be challenging to diagnose and treat. Cannulated scaphoid screws have made percutaneous stabilization highly effective. Questions Would minimally invasive operative treatment of minimally displaced scaphoid fractures yield faster return to work when compared with patients treated conservatively? How do functional and patient satisfaction scores compare between the two groups at 12-months follow-up? Patients and Methods Records from 18 patients (mean age 28.6 years) treated surgically were retrospectively reviewed and compared with a group of 10 patients (mean age 33.3 years, p = 0.74) treated nonoperatively. Inclusion criteria were a minimum follow-up period of 12 months and radiographic union. Time to return to work was compared between groups. At 12 months' follow-up, wrist range of motion (ROM) and grip strength were compared, as well as pain, satisfaction, and overall wrist function were evaluated by the visual analogue scale (VAS) and the Mayo modified wrist score (MMWS). Results The mean time to return to work for the operated group was 39.75 days, while for the nonoperated group it was 88.14 days ( p = 0.002). At the 12 months' follow-up, mean ROM, grip strength, and VAS score did not differ between groups. The mean MMWS was 98.75 for the operated group and 87.5 for the nonoperated group, indicating a better result in patients treated operatively ( p = 0.03). In addition, two failures of instrumentation were recorded, a seldom seen complication. Conclusion Percutaneous fixation of minimally displaced scaphoid fractures allows faster return to work and leaves patients more satisfied with their wrist function compared with plaster immobilization at 12 months' follow-up. Level of evidence This is a Level III, retrospective, case-control study.
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Affiliation(s)
- Apostolos Fyllos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - George Komnos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Athanasios Koutis
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Konstantinos Bargiotas
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Nikaia, Larissa, Greece
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Erhart J, Unger E, Trulson I, Hagmann M, Ristl R, Trulson A, Hajdu S, Schefzig P, Gormasz A, Mayr W. Pull-out forces of headless compression screws in variations of synthetic bone models imitating different types of scaphoid fractures in good bone quality. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:92. [PMID: 33089376 DOI: 10.1007/s10856-020-06445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
Screw osteosynthesis using headless compression screws has become the accepted gold standard for the surgical treatment of scaphoid fractures. Optimal screw specifications remain controversially discussed. We aimed to investigate the influence of bone model composition on screw stability tests using headless compression screws in different scaphoid fracture models. We conducted pull-out tests using Acutrak2®mini, HCS®, HKS®, HBS®, Herbert/Whipple® and Twinfix® screws. To imitate cortical and cancellous bone, two-layer polyurethane (PU) models with two distinct densities were produced. The cylinders were cut at different positions to replicate fracture localisations at increasing distances. The maximum pull-out force required to achieve up to 1 mm of pull-out distance (Nto 1 mm) was measured. Acutrak2®mini and HCS® followed by Twinfix® showed the greatest average pull-out forces. Nto 1 mm was, on average, greater in the cortico-cancellous model than in the cancellous cylinder with the Acutrak2®mini and the Herbert/Whipple® screws, while it was the least with the HBS® and the Twinfix® screws; there were also differences between the HCS® and HKS®. There were no differences between the different fracture simulations in the synthesis strength using either the HKS® or HBS®. The pull-out forces of the HCS® and Twinfix® remained high also in simulations with the smaller screw base fragments. Varying imitations of cancellous and cortico-cancellous bone and fracture localisation reveal important information about the ex vivo strength of screw syntheses. The grip of the cortical structure should be used with the screws that fit more firmly in cortico-cancellous bone.
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Affiliation(s)
- Jochen Erhart
- Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Inga Trulson
- Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Hagmann
- Section of Medical Statistics at the Core Unit of Medical Statistics and Informatics, University of Vienna, Spitalgasse 23, A-1090, Wien, Austria
| | - Robin Ristl
- Section of Medical Statistics at the Core Unit of Medical Statistics and Informatics, University of Vienna, Spitalgasse 23, A-1090, Wien, Austria
| | - Alexander Trulson
- BG Clinic Tuebingen, Schnarrenbergstr. 95, D-72076, Tuebingen, Germany
| | - Stefan Hajdu
- Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philip Schefzig
- Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anna Gormasz
- Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Vishwanathan K, Patel R, Talwalkar S. Which Headless Compression Screw Produces the Highest Interfragmentary Compression Force in Scaphoid Fracture? Indian J Orthop 2020; 54:548-564. [PMID: 32850017 PMCID: PMC7429644 DOI: 10.1007/s43465-020-00107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Interfragmentary compression at the fracture site facilitates healing. Headless compression screws used to treat scaphoid fractures can be grouped as shank screws, conical tapered screws and double component screws. There has been no meta-analysis of biomechanical studies to compare interfragmentary compression produced by the above screws. METHODS A computerised search of Pubmed, Embase and OVID database was undertaken to identify the studies. We estimated the weighted mean difference of interfragmentary compression (in Newton) with 95% confidence intervals. Random effects model was selected for meta-analysis. RESULTS The pooled estimate of nine studies demonstrated that conical tapered screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 19.96, 95% CI 11.2-28.8, p < 0.0001, I 2 = 99%). The pooled estimate of four studies demonstrated that dual component screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 16.93, 95% CI 12.3-21.6, p < 0.0001, I 2 = 97.7%). The pooled estimate of four studies showed that there was no significant difference in the interfragmentary compression force generated by either conical tapered screw or dual component screw (WMD 3.93, 95% CI - 8.3 to 16.2, p = 0.53, I 2 = 99.7%). There was evidence of minimal publication bias. CONCLUSION Conical tapered screws and dual component screws produced statistically significant higher interfragmentary compression force at the scaphoid fracture site compared to shank screws. There was no difference in the compression force generated by either conical tapered screw or dual component screw.
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, P.O Limda, Waghodia, Vadodara, 391760 India
| | - Ravi Patel
- Pramukhswami Medical College, Charutar Arogya Mandal, Gokal Nagar, Karamsad, 388325 India
| | - Sumedh Talwalkar
- Department of Orthopaedics, Wrightington, Wigan and Leigh NHS Trust, Wrightington, WN6 9EP UK
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Graul I, Lindner R, Schettler N, Friedel R, Hofmann GO. Deviations in positioning variable pitch screws- scaphoid waist fractures. Orthop Traumatol Surg Res 2020; 106:347-351. [PMID: 31899116 DOI: 10.1016/j.otsr.2019.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/10/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Operative therapy using a headless cannulated variable pitch compression screw is the gold standard for the treatment of instable scaphoid fractures. HYPOTHESIS Deviation from the central placement is associated with a loss of stability and stiffness. MATERIAL AND METHODS An artificial bone model was manufactured and different screw positions (central, 10° and 20° to the long axis) were assessed. A shearing test with axial force on the 45° flexed scaphoid was applied. RESULTS The inserted variable pitch screw showed the highest stiffness and failure force in a position in the long axis. At 10 degrees, a slight decrease in stiffness (32.7N/mm±9.3N/mm) and failure force (41.6N±13.2N) was observed, while a significant reduction in stiffness (29.3N/mm±4.6N/mm) and failure force (50.3N±19.5N) was measured at 20 degrees. DISCUSSION Deviations in the angle of insertion of the compression screw cause loss in failure force, thus deviations from the central placement is associated with less stability and stiffness. LEVEL OF PROOF Controlled laboratory study (basic science study, biomechanical testing).
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Affiliation(s)
- Isabel Graul
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany.
| | - Robert Lindner
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany
| | - Nicky Schettler
- Department of Trauma, Orthopedics and hand surgery, Helios Erfurt, Germany
| | - Reinhard Friedel
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany
| | - Gunther O Hofmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany; Department of Trauma, BG Bergmanstrost, Halle, Germany
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Patel S, Giugale J, Tiedeken N, Debski RE, Fowler JR. Impact of Screw Length on Proximal Scaphoid Fracture Biomechanics. J Wrist Surg 2019; 8:360-365. [PMID: 31579543 PMCID: PMC6773614 DOI: 10.1055/s-0039-1685514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
Background Proximal scaphoid fractures display high nonunion rates and increased revision cases. Waist fracture fixation involves maximizing screw length within the cortex; however, the optimal screw length for proximal scaphoid fractures remains unknown. Purpose The main purpose of this article is to compare stiffness and ultimate load for proximal scaphoid fracture fixation of various headless compression screw lengths. Methods Eighteen scaphoids underwent an osteotomy simulating a 7 mm oblique proximal fracture. Screws of three lengths (10, 18, and 24 mm) were randomly assigned for fixation. Each specimen underwent cyclic loading with stiffness calculated during the last loading cycle. Specimens that withstood cyclic loading were loaded to failure. Results No significant difference in stiffness between screw lengths was found. Ultimate load was significantly impacted by the screw length. A significant difference in ultimate load between a 10 and 24 mm screw was found; however, no significant difference occurred in ultimate load between an 18 and 24 mm screw. Conclusions No significant difference in stiffness between all groups could be due to similarities in purchase in the proximal aspect. The 10 mm screw withstanding less ultimate load compared to the 24 mm screw could be due to the 10 mm screw gaining less purchase on either side of the fracture site compared to the 24 mm screw. Lack of significant difference in ultimate load between the 18 and 24 mm screw could be occurring because the fracture site is closer to the 18 mm screw midpoint, as distal threads are engaged closer to the fracture. Clinical Relevance Maximizing screw length may not provide superior fixation biomechanically compared with fixation utilizing a 6 mm shorter screw for proximal scaphoid fractures.
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Affiliation(s)
- Samik Patel
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan Giugale
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nathan Tiedeken
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard E. Debski
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John R. Fowler
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Kim HS, Kang HJ, Choi YR, Oh WT, Koh IH. A comparative study of the effect of drilling depth on generation of compressive force by headless compression screws using conical and cylindrical type of drill bit. J Orthop Surg Res 2019; 14:5. [PMID: 30609926 PMCID: PMC6318908 DOI: 10.1186/s13018-018-1044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background This study was conducted to measure the effect of different drilling depths on compression forces generated by two commonly used headless compression screws using the two different types of drill bit, the Acutrak® mini (conical type drill bit) and the Synthes 3.0 HCS® (cylindrical type drill bit). Methods A load cell was placed between two Sawbone blocks, which were 12 mm and 40 mm in thickness, respectively. After placing the guide pin into the center of the block, the drilling depth of the Acutrak® mini and Synthes HCS® screws ranged from 16 to 28 mm and 22 to 28 mm, respectively. The 24-mm screws were inserted and the compression force was measured immediately and at 30 min post-insertion. Results The Acutrak® mini generated greater compression force compared to the Synthes 3.0 HCS® when drilled to a depth of less than 24 mm. The compression force of the Acutrak® mini showed a strong inverse correlation with the drilling depth. There was no significant inverse correlation observed between the compression force of the Synthes HCS® and the drilling depth. Conclusions If the screw length and the drill depth are the same, the Synthes 3.0 HCS® (cylindrical type drill bit) is safer and easier to use as it has no change in the compression force even when over-drilling because the compression force of the two screws is similar. As for the Acutrak® mini (conical type drill bit), while it is technically demanding due to varying compression force according to the drill depth, it can be used in certain cases because it can give stronger compression force through under-drilling.
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Affiliation(s)
- Hyung-Sik Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
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Quan Q, Hong L, Chang B, Liu R, Zhu Y, Peng J, Zhao Q, Lu S. The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views. PLoS One 2017; 12:e0170677. [PMID: 28114317 PMCID: PMC5256911 DOI: 10.1371/journal.pone.0170677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to simulate and calculate the probability of iatrogenic perforation of the scaphoid cortical bone when internal fixation appeared to be safe on radiographs. The results will assist surgeons in determining proper screw placement. METHODS Thirty scaphoids were reconstructed using computed tomography data and image-processing software. Different central axes were determined by the software to simulate the surgical views. The safe zone (SZ) and risk zone (RZ) were identified on the axial projection radiographs by comparing the scaphoid bone stenosis measured by the fluoroscopic radiographs with a three-dimensional reconstruction of the scaphoid stenosis. Each original axial projection radiograph was zoomed and compiled to match a calculated average image. The RZ, SZ, and probability of perforations in various quadrants were calculated. RESULTS Using a volar view (approach), the mean risks of cortical perforation were 25% with screws and 36% with k-wires. Using a dorsal view (approach), the mean risks of cortical perforation were 18% with screws and 30% with k-wires. A high risk of perforation was detected at the ulnar-dorsal zone. CONCLUSION Surgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, particularly in the ulnar-dorsal and radial-dorsal quadrants, because such screws are likely to perforate the cortex. The position of the internal fixator should be assessed using a diagram outlining the various SZs. Therapeutic, Level III.
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Affiliation(s)
- Qi Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Lei Hong
- Department of Orthopedic Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Biao Chang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ruoxi Liu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yun Zhu
- School of the Biomedical of Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU), Hong Kong, China
| | - Jiang Peng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Qing Zhao
- Department of Orthopedic Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
- * E-mail: (SL); (QZ)
| | - Shibi Lu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
- * E-mail: (SL); (QZ)
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Bolm I, Goetze E, Kämmerer PW, Sader R, Klos M, Landes C, Al-Nawas B. Self-drilling and self-tapping miniscrews for osteosynthesis fixture after LeFort I osteotomy: An ex vivo trial for primary stability and a randomized clinical study. J Surg Res 2016; 212:246-252. [PMID: 28550914 DOI: 10.1016/j.jss.2016.08.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 04/29/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Self-drilling osteosynthesis screws (SDS) have a potential higher primary stability together with clinical advantages such as less time effort compared to self-tapping screws (STS). The aims of the study were to compare the primary stability of SDS and STS ex vivo and to analyze of the time-saving effect in vivo. MATERIALS AND METHODS Ex vivo, both screws were placed in porcine bone. Torque was measured for insertion and removal. Four specimens were kept in bone for histologic bone-to-implant-contact examination. In vivo, 49 patients who received orthognathic surgery in the maxilla were included in 2 centers. In a split-mouth design, the time for osteosynthesis fixation and perioperative events were recorded. RESULTS Ex vivo, insertion and removal torque measurements were higher for SDS, especially in dense bone. Histologic imaging on the exemplary-stained specimens showed higher bone contact and compressed bone matrix for SDS in all bone densities. In vivo, the mean osteosynthesis time in both centers was 5.5 min (±3.03) for SDS and 5.5 min (±2.37) for STS. Separate analysis showed that center I was faster with STS and center II with SDS. Although, in center I a higher rate of failed primary stability of SDS compared to STS was documented. CONCLUSIONS SDS showed a partially higher primary stability ex vivo, especially in dense bone. The timesaving effect of SDS is less pronounced than expected, but technically SDS might be favorable where drilling is difficult or even impossible.
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Affiliation(s)
- Irina Bolm
- Department of Cranio-Maxillo-Facial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Elisabeth Goetze
- Department of Cranio-Maxillo-Facial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peer W Kämmerer
- Department of Cranio-Maxillo-Facial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Sader
- Department of Cranio-Maxillo-Facial and Plastic Surgery of the University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michelle Klos
- Department of Cranio-Maxillo-Facial and Plastic Surgery of the University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Constantin Landes
- Department of Cranio-Maxillo-Facial and Plastic Surgery of the University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Bilal Al-Nawas
- Department of Cranio-Maxillo-Facial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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