A novel electromagnetic navigation tool for acetabular surgery.

PubMed

Lehmann, Wolfgang; Rueger, Johannes M; Nuechtern, Jakob; Grossterlinden, Lars; Kammal, Michael; Hoffmann, Michael

2015-10-01

Acetabular fracture surgery is demanding and screw placement along narrow bony corridors remains challenging. It necessitates x-ray radiation for fluoroscopically assisted screw insertion. The purpose of this cadaver study was to evaluate the feasibility, accuracy and operation time of a novel electromagnetic navigation system for screw insertion along predefined acetabular corridors. A controlled laboratory study with a total of 24 electromagnetically navigated screw insertions was performed on 8 cadaveric acetabula. 3 peri-acetabular bony corridors (QSS, Quadrilateral Surface Screw; IAS, Infra-Acetabular Screw; PCS, Posterior Column Screw) were defined and screws were placed in a defined order without fluoroscopy. Operation time was documented. Postoperative CT scans were performed to analyse accuracy of screw placement. Mean cadaver age was 70.4 ± 11.7. Successful screw placement was accomplished in 22 out of 24 (91.7%) cases. The overall mean time for all 3 acetabular screws was 576.6 ± 75.9s. All 3 complications occurred during the placement of the IAS due to an impassable narrow bony corridor. QSS mean length was 50 ± 5mm, IAS mean length was 85 ± 10mm and PCS mean length was 120 ± 5mm. In this cadaver study the novel electromagnetic navigation system was feasible to allow accurate screw placement without fluoroscopy in defined narrow peri-acetabular bony corridors. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preliminary Design on Screw Press Model of Palm Oil Extraction Machine

NASA Astrophysics Data System (ADS)

Firdaus, Muhammad; Salleh, S. M.; Nawi, I.; Ngali, Z.; Siswanto, W. A.; Yusup, E. M.

2017-01-01

The concept of the screw press is to compress the fruit bunch between the main screw and travelling cones to extract the palm oil. Visual inspection, model development and simulation of screw press by using Solidworks 2016 and calculation of design properties were performed to support the investigation. The project aims to analyse different design of screw press which improves in reducing maintenance cost and increasing lifespan. The currently existing of screw press can endure between 500 to 900 hours and requires frequent maintenance. Different configurations have been tried in determination of best design properties in screw press. The results specify that screw press with tapered inner shaft has more total lifespan (hours) compared existing screw press. The selection of the screw press with tapered inner shaft can reduce maintenance cost and increase lifespan of the screw press.

Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study.

PubMed

Gazelka, Halena M; Welch, Tasha L; Nassr, Ahmad; Lamer, Tim J

2015-05-01

To determine whether the thermal energy associated with lumbar spine radiofrequency neurotomy (RFN) performed near titanium and stainless steel pedicle screws is conducted to the pedicle screws or adjacent tissues, or both, thus introducing potential for thermal damage to those tissues. Cadaver study. Cadaver laboratory equipped with fluoroscopy, surgical spine implements, and radiofrequency generator. No live human subject; a fresh frozen (and thawed) cadaver torso was used for the study. Titanium and stainless steel pedicle screws were placed in the lumbar spine of a fresh frozen cadaver torso with real-time fluoroscopic guidance. Conventional RFN cannula placement was performed at the level of pedicle screws and a control (nonsurgically altered) lumbar level. Neurotomy was performed with conventional radiofrequency lesioning parameters. Temperatures were recorded at multiple sites through thermistor probes. Direct contact of the radiofrequency cannula with the pedicle screws during conventional RFN produced a substantial increase in temperature in the surrounding soft tissues. A small increase in temperature occurred at the same sites at the control level. Titanium and stainless steel pedicle screws are capable of sustaining large increases in temperature when the radiofrequency probe comes in contact with the screw. These results are suggestive that pedicle screws could serve as a possible source of tissue heating and thermal injury during RFN. Wiley Periodicals, Inc.

Time-elapsed screw insertion with microCT imaging.

PubMed

Ryan, M K; Mohtar, A A; Cleek, T M; Reynolds, K J

2016-01-25

Time-elapsed analysis of bone is an innovative technique that uses sequential image data to analyze bone mechanics under a given loading regime. This paper presents the development of a novel device capable of performing step-wise screw insertion into excised bone specimens, within the microCT environment, whilst simultaneously recording insertion torque, compression under the screw head and rotation angle. The system is computer controlled and screw insertion is performed in incremental steps of insertion torque. A series of screw insertion tests to failure were performed (n=21) to establish a relationship between the torque at head contact and stripping torque (R(2)=0.89). The test-device was then used to perform step-wise screw insertion, stopping at intervals of 20%, 40%, 60% and 80% between screw head contact and screw stripping. Image data-sets were acquired at each of these time-points as well as at head contact and post-failure. Examination of the image data revealed the trabecular deformation as a result of increased insertion torque was restricted to within 1mm of the outer diameter of the screw thread. Minimal deformation occurred prior to the step between the 80% time-point and post-failure. The device presented has allowed, for the first time, visualization of the micro-mechanical response in the peri-implant bone with increased tightening torque. Further testing on more samples is expected to increase our understanding of the effects of increased tightening torque at the micro-structural level, and the failure mechanisms of trabeculae. Copyright © 2015 Elsevier Ltd. All rights reserved.

Design and application of electromechanical actuators for deep space missions

NASA Technical Reports Server (NTRS)

Haskew, Tim A.; Wander, John

1993-01-01

During the period 8/16/92 through 2/15/93, work has been focused on three major topics: (1) screw modeling and testing; (2) motor selection; and (3) health monitoring and fault diagnosis. Detailed theoretical analysis has been performed to specify a full dynamic model for the roller screw. A test stand has been designed for model parameter estimation and screw testing. In addition, the test stand is expected to be used to perform a study on transverse screw loading.

Virtual surgery simulation versus traditional approaches in training of residents in cervical pedicle screw placement.

PubMed

Hou, Yang; Shi, Jiangang; Lin, Yanping; Chen, Huajiang; Yuan, Wen

2018-06-01

The cervical screw placement is one of the most difficult procedures in spine surgery, which often needs a long period of repeated practices and could cause screw placement-related complications. We performed this cadaver study to investigate the effectiveness of virtual surgical training system (VSTS) on cervical pedicle screw instrumentation for residents. A total of ten novice residents were randomly assigned to two groups: the simulation training (ST) group (n = 5) and control group (n = 5). The ST group received a surgical training of cervical pedicle screw placement on VSTS and the control group was given an introductory teaching session before cadaver test. Ten fresh adult spine specimens including 6 males and 4 females were collected, and were randomly allocated to the two groups. The bilateral C3-C6 pedicle screw instrumentation was performed in the specimens of the two groups, respectively. After instrumentation, screw positions of the two groups were evaluated by image examinations. There was significantly statistical difference in screw penetration rates between the ST (10%) and control group (62.5%, P < 0.05). The acceptable rates of screws were 100 and 50% in the ST and control groups with significant difference between each other (P < 0.05). In addition, the average screw penetration distance in the ST group (1.12 ± 0.47 mm) was significantly lower than the control group (2.08 ± 0.39 mm, P < 0.05). This study demonstrated that the VSTS as an advanced training tool exhibited promising effects on improving performance of novice residents in cervical pedicle screw placement compared with the traditional teaching methods.

Feasibility of detecting orthopaedic screw overtightening using acoustic emission.

PubMed

Pullin, Rhys; Wright, Bryan J; Kapur, Richard; McCrory, John P; Pearson, Matthew; Evans, Sam L; Crivelli, Davide

2017-03-01

A preliminary study of acoustic emission during orthopaedic screw fixation was performed using polyurethane foam as the bone-simulating material. Three sets of screws, a dynamic hip screw, a small fragment screw and a large fragment screw, were investigated, monitoring acoustic-emission activity during the screw tightening. In some specimens, screws were deliberately overtightened in order to investigate the feasibility of detecting the stripping torque in advance. One set of data was supported by load cell measurements to directly measure the axial load through the screw. Data showed that acoustic emission can give good indications of impending screw stripping; such indications are not available to the surgeon at the current state of the art using traditional torque measuring devices, and current practice relies on the surgeon's experience alone. The results suggest that acoustic emission may have the potential to prevent screw overtightening and bone tissue damage, eliminating one of the commonest sources of human error in such scenarios.

Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty.

PubMed

Singh, Nishant Kumar; Rai, Sanjay Kumar; Rastogi, Amit

2017-01-01

Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation. In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities. The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery. Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al . on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al . is required for acetabular implants with eccentric holes for fixation of acetabular screws.

Failure analysis of broken pedicle screws on spinal instrumentation.

PubMed

Chen, Chen-Sheng; Chen, Wen-Jer; Cheng, Cheng-Kung; Jao, Shyh-Hua Eric; Chueh, Shan-Chang; Wang, Chang-Chih

2005-07-01

Revised spinal surgery is needed when there is a broken pedicle screw in the patient. This study investigated the pedicle screw breakage by conducting retrieval analyses of broken pedicle screws from 16 patients clinically and by performing stress analyses in the posterolateral fusion computationally using finite element (FE) models. Fracture surface of screws was studied by scanning electron microscope (SEM). The FE model of the posterolateral fusion with the screw showed that screws on the caudal side had larger axial stress than those on the cephalic side, supporting the clinical findings that 75% of the patients had the screw breakage on the caudal side. SEM fractography showed that all broken screws exhibited beach marks or striations on the fractured surface, indicating fatigue failure. Screws of patients with spinal fracture showed fatigue striations and final ductile fracture around the edge. Among the 16 patients who had broken pedicle screws 69% of them achieved bone union in the bone graft, showing that bone union in the bone graft did not warrant the prevention of screw breakage.

Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis.

PubMed

Latt, L Daniel; Glisson, Richard R; Adams, Samuel B; Schuh, Reinhard; Narron, John A; Easley, Mark E

2015-10-01

Transverse tarsal joint arthrodesis is commonly performed in the operative treatment of hindfoot arthritis and acquired flatfoot deformity. While fixation is typically achieved using screws, failure to obtain and maintain joint compression sometimes occurs, potentially leading to nonunion. External fixation is an alternate method of achieving arthrodesis site compression and has the advantage of allowing postoperative compression adjustment when necessary. However, its performance relative to standard screw fixation has not been quantified in this application. We hypothesized that external fixation could provide transverse tarsal joint compression exceeding that possible with screw fixation. Transverse tarsal joint fixation was performed sequentially, first with a circular external fixator and then with compression screws, on 9 fresh-frozen cadaveric legs. The external fixator was attached in abutting rings fixed to the tibia and the hindfoot and a third anterior ring parallel to the hindfoot ring using transverse wires and half-pins in the tibial diaphysis, calcaneus, and metatarsals. Screw fixation comprised two 4.3 mm headless compression screws traversing the talonavicular joint and 1 across the calcaneocuboid joint. Compressive forces generated during incremental fixator foot ring displacement to 20 mm and incremental screw tightening were measured using a custom-fabricated instrumented miniature external fixator spanning the transverse tarsal joint. The maximum compressive force generated by the external fixator averaged 186% of that produced by the screws (range, 104%-391%). Fixator compression surpassed that obtainable with screws at 12 mm of ring displacement and decreased when the tibial ring was detached. No correlation was found between bone density and the compressive force achievable by either fusion method. The compression across the transverse tarsal joint that can be obtained with a circular external fixator including a tibial ring exceeds that which can be obtained with 3 headless compression screws. Screw and external fixator performance did not correlate with bone mineral density. This study supports the use of external fixation as an alternative method of generating compression to help stimulate fusion across the transverse tarsal joints. The findings provide biomechanical evidence to support the use of external fixation as a viable option in transverse tarsal joint fusion cases in which screw fixation has failed or is anticipated to be inadequate due to suboptimal bone quality. © The Author(s) 2015.

Use of CFD to predict trapped gas excitation as source of vibration and noise in screw compressors

NASA Astrophysics Data System (ADS)

Willie, James

2017-08-01

This paper investigates the source of noise in oil free screw compressors mounted on highway trucks and driven by a power take-off (PTO) transmission system. Trapped gas at the discharge side is suggested as possible source of the excitation of low frequency torsional resonance in these compressors that can lead to noise and vibration. Measurements and lumped mass torsional models have shown low frequency torsional resonance in the drive train of these compressors when they are mounted on trucks. This results in high torque peak at the compressor input shaft and in part to pulsating noise inside the machine. The severity of the torque peak depends on the amplitude of the input torque fluctuation from the drive (electric motor or truck engine). This in turn depends on the prop-shaft angle. However, the source of the excitation of this low torsional resonance inside the machine is unknown. Using CFD with mesh motion at every 1° rotation of the rotors, it is shown that the absence of a pressure equalizing chamber at the discharge can lead to trapped gas creation, which can lead to over-compression, over-heating of the rotors, and to high pressure pulsations at the discharge. Over-compression can lead to shock wave generation at the discharge plenum and the pulsation in pressure can lead to noise generation. In addition, if the frequency of the pressure pulsation in the low frequency range coincides with the first torsional frequency of the drive train the first torsional resonance mode can be excited.

Are allogenic or xenogenic screws and plates a reasonable alternative to alloplastic material for osteosynthesis--a histomorphological analysis in a dynamic system.

PubMed

Jacobsen, C; Obwegeser, J A

2010-12-01

Despite invention of titanium and resorbable screws and plates, still, one of the main challenges in bone fixation is the search for an ideal osteosynthetic material. Biomechanical properties, biocompatibility, and also cost effectiveness and clinical practicability are factors for the selection of a particular material. A promising alternative seems to be screws and plates made of bone. Recently, xenogenic bone pins and screws have been invented for use in joint surgery. In this study, screws made of allogenic sheep and xenogenic human bone were analyzed in a vital and dynamic sheep-model and compared to conventional titanium screws over a standard period of bone healing of 56 days with a constant applied extrusion force. Biomechanical analysis and histomorphological evaluation were performed. After 56 days of insertion xenogenic screws made of human bone showed significantly larger distance of extrusion of on average 173.8 μm compared to allogenic screws made of sheep bone of on average 27.8 and 29.95 μm of the titanium control group. Severe resorption processes with connective tissue interposition were found in the histomorphological analysis of the xenogenic screws in contrast to new bone formation and centripetal vascularization of the allogenic bone screw, as well as in processes of incorporation of the titanium control group. The study showed allogenic cortical bone screws as a substantial alternative to titanium screws with good biomechanical properties. In contrast to other reports a different result was shown for the xenogenic bone screws. They showed insufficient holding strength with confirmative histomorphological signs of degradation and insufficient osseointegration. Before common clinical use of xenogenic osteosynthetic material, further evaluation should be performed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Early experience of placing image-guided minimally invasive pedicle screws without K-wires or bone-anchored trackers.

PubMed

Malham, Gregory M; Parker, Rhiannon M

2018-04-01

OBJECTIVE Image guidance for spine surgery has been reported to improve the accuracy of pedicle screw placement and reduce revision rates and radiation exposure. Current navigation and robot-assisted techniques for percutaneous screws rely on bone-anchored trackers and Kirchner wires (K-wires). There is a paucity of published data regarding the placement of image-guided percutaneous screws without K-wires. A new skin-adhesive stereotactic patient tracker (SpineMask) eliminates both an invasive bone-anchored tracker and K-wires for pedicle screw placement. This study reports the authors' early experience with the use of SpineMask for "K-wireless" placement of minimally invasive pedicle screws and makes recommendations for its potential applications in lumbar fusion. METHODS Forty-five consecutive patients (involving 204 screws inserted) underwent K-wireless lumbar pedicle screw fixation with SpineMask and intraoperative neuromonitoring. Screws were inserted by percutaneous stab or Wiltse incisions. If required, decompression with or without interbody fusion was performed using mini-open midline incisions. Multimodality intraoperative neuromonitoring assessing motor and sensory responses with triggered electromyography (tEMG) was performed. Computed tomography scans were obtained 2 days postoperatively to assess screw placement and any cortical breaches. A breach was defined as any violation of a pedicle screw involving the cortical bone of the pedicle. RESULTS Fourteen screws (7%) required intraoperative revision. Screws were removed and repositioned due to a tEMG response < 13 mA, tactile feedback, and 3D fluoroscopic assessment. All screws were revised using the SpineMask with the same screw placement technique. The highest proportion of revisions occurred with Wiltse incisions (4/12, 33%) as this caused the greatest degree of SpineMask deformation, followed by a mini midline incision (3/26, 12%). Percutaneous screws via a single stab incision resulted in the fewest revisions (7/166, 4%). Postoperative CT demonstrated 7 pedicle screw breaches (3%; 5 lateral, 1 medial, 1 superior), all with percutaneous stab incisions (7/166, 4%). The radiological accuracy of the SpineMask tracker was 97% (197/204 screws). No patients suffered neural injury or required postoperative screw revision. CONCLUSIONS The noninvasive cutaneous SpineMask tracker with 3D image guidance and tEMG monitoring provided high accuracy (97%) for percutaneous pedicle screw placement via stab incisions without K-wires.

Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws.

PubMed

Lapsiwala, Samir B; Anderson, Paul A; Oza, Ashish; Resnick, Daniel K

2006-03-01

We performed a biomechanical comparison of several C1 to C2 fixation techniques including crossed laminar (intralaminar) screw fixation, anterior C1 to C2 transarticular screw fixation, C1 to 2 pedicle screw fixation, and posterior C1 to C2 transarticular screw fixation. Eight cadaveric cervical spines were tested intact and after dens fracture. Four different C1 to C2 screw fixation techniques were tested. Posterior transarticular and pedicle screw constructs were tested twice, once with supplemental sublaminar cables and once without cables. The specimens were tested in three modes of loading: flexion-extension, lateral bending, and axial rotation. All tests were performed in load and torque control. Pure bending moments of 2 nm were applied in flexion-extension and lateral bending, whereas a 1 nm moment was applied in axial rotation. Linear displacements were recorded from extensometers rigidly affixed to the C1 and C2 vertebrae. Linear displacements were reduced to angular displacements using trigonometry. Adding cable fixation results in a stiffer construct for posterior transarticular screws. The addition of cables did not affect the stiffness of C1 to C2 pedicle screw constructs. There were no significant differences in stiffness between anterior and posterior transarticular screw techniques, unless cable fixation was added to the posterior construct. All three posterior screw constructs with supplemental cable fixation provide equal stiffness with regard to flexion-extension and axial rotation. C1 lateral mass-C2 intralaminar screw fixation restored resistance to lateral bending but not to the same degree as the other screw fixation techniques. All four screw fixation techniques limit motion at the C1 to 2 articulation. The addition of cable fixation improves resistance to flexion and extension for posterior transarticular screw fixation.

Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

PubMed Central

Singh, Nishant Kumar; Rai, Sanjay Kumar; Rastogi, Amit

2017-01-01

Background: Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation. Materials and Methods: In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities. Results: The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery. Conclusion: Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al. on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al. is required for acetabular implants with eccentric holes for fixation of acetabular screws. PMID:28790474

Analysis of stress induced by screws in the vertebral fixation system

PubMed Central

Fakhouri, Sarah Fakher; Shimano, Marcos Massao; de Araújo, Cleudmar Amaral; Defino, Helton Luiz Aparecido; Shimano, Antônio Carlos

2014-01-01

Objective: To compare, using photoelasticity, internal stress produced by USS II type screw with 5.2 and 6.2 mm external diameters, when submitted to three different pullout strengths. Methods: Two photoelastic models were especially made. The simulation was performed using loads of 1.8, 2.4 e 3.3 kgf.The fringe orders were evaluated around the screws. In all the models analyzed the shear stress were calculated. Results: Independently of the applied load, the smaller screw showed higher values of shear stress. Conclusion: According to the analysis performed, we observed that the place of highest stress was in the first thread of the lead, close to the head of the screws. Experimental study. PMID:24644414

Load Fatigue Performance Evaluation on Two Internal Tapered Abutment-Implant Connection Implants Under Different Screw Tightening Torques.

PubMed

Jeng, Ming-Dih; Liu, Po-Yi; Kuo, Jia-Hum; Lin, Chun-Li

2017-04-01

This study evaluates the load fatigue performance of different abutment-implant connection implant types-retaining-screw (RS) and taper integrated screwed-in (TIS) types under 3 applied torque levels based on the screw elastic limit. Three torque levels-the recommended torque (25 Ncm), 10% less, and 10% more than the ratio of recommended torque to screw elastic limits of different implants were applied to the implants to perform static and dynamic testing according to the ISO 14801 method. Removal torque loss was calculated for each group after the endurance limitation was reached (passed 5 × 10 6 cycles) in the fatigue test. The static fracture resistance results showed that the fracture resistance in the TIS-type implant significantly increased (P < .05) when the abutment screw was inserted tightly. The dynamic testing results showed that the endurance limitations for the RS-type implant were 229 N, 197 N, and 224 N and those for the TIS-type implant were 322 N, 364 N, and 376 N when the screw insertion torques were applied from low to high. The corresponding significant (P < .05) removal torque losses for the TIS-type implant were 13.2%, 5.3%, and 2.6% but no significant difference was found for the RS-type implant. This study concluded that the static fracture resistance and dynamic endurance limitation of the TIS-type implant (1-piece solid abutment) increased when torque was applied more tightly on the screw. Less torque loss was also found when increasing the screw insertion torque.

Torsional stiffness after subtalar arthrodesis using second generation headless compression screws: Biomechanical comparison of 2-screw and 3-screw fixation.

PubMed

Riedl, Markus; Glisson, Richard R; Matsumoto, Takumi; Hofstaetter, Stefan G; Easley, Mark E

2017-06-01

Subtalar joint arthrodesis is a common operative treatment for symptomatic subtalar arthrosis. Because excessive relative motion between the talus and calcaneus can delay or prohibit fusion, fixation should be optimized, particularly in patients at risk for subtalar arthrodesis nonunion. Tapered, fully-threaded, variable pitch screws are gaining popularity for this application, but the mechanical properties of joints fixed with these screws have not been characterized completely. We quantified the torsion resistance of 2-screw and 3-screw subtalar joint fixation using this type of screw. Ten pairs of cadaveric subtalar joints were prepared for arthrodesis and fixed using Acutrak 2-7.5 screws. One specimen from each pair was fixed with two diverging posterior screws, and the contralateral joint was fixed using two posterior screws and a third screw directed through the anterior calcaneus into the talar neck. Internal and external torsional loads were applied and joint rotation and torsional stiffness were measured at two torque levels. Internal rotation was significantly less in specimens fixed with three screws. No difference was detectable between 2-screw and 3-screw fixation in external rotation or torsional stiffness in either rotation direction. Both 2-screw and 3-screw fixation exhibited torsion resistance surpassing that reported previously for subtalar joints fixed with two diverging conventional lag screws. Performance of the tapered, fully threaded, variable pitch screws exceeded that of conventional lag screws regardless of whether two or three screws were used. Additional resistance to internal rotation afforded by a third screw placed anteriorly may offer some advantage in patients at risk for nonunion. Copyright © 2017. Published by Elsevier Ltd.

Surface characteristics of clinically used dental implant screws

NASA Astrophysics Data System (ADS)

Han, Myung-Ju; Choe, Han-Cheol; Chung, Chae-Heon

2005-12-01

Surface alteration of implant screws after function may be associated with mechanicalffailure. This type of metal fatigue appears to be the most common cause of structural failure. The purpose of this study was to evaluate surface alteration of implant screws after function through an examination of used and unused implant screws via scanning electron microscopy (SEM). In this study, abutment screws (Steri-oss, 3i, USA), gold retaining screws (3i, USA), and titanium retaining screws (3i, USA) were retrieved from patients, New, unused abutment, and retaining screws were prepared for a control group. Each of the old, used screws was retrieved with a screwdriver. The retrieved implant complex of a Steri-oss system was also prepared for this study. SEM investigation and energy dispersive spectroscopy (EDS) analysis of the abutment and retaining screws were then performed, as well as SEM investigation of a cross-sectioned sample of the retrieved implant complex in the case of new, unused implant screws, as-manufactured circumferential grooves were regularly examined and screw threads were sharply maintained. Before ultrasonic cleansing of old, used implant screws, there was a large amount of debris accumulation and corrosion products. After ultrasonic cleansing of old, used implant screws, circumferential grooves were examined were found to be randomly deepened and scratching increased. Also, dull screw fhreads were observed. More surface alterations after function were observed in titanium screws than in gold screws. Furthermore, more surface alteration was observed when the screws were retrieved with a driver than without a driver. These surface alterations after function may result in screw instability. Regular cleansing and exchange of screws is therefore recommended. We also recommend the use of gold screws over titanium screws, and careful manipulation of the driver.

Influence of Prosthetic Screw Material on Joint Stability in Passive and Non-Passive Implant-Supported Dentures

PubMed Central

Spazzin, Aloísio Oro; Henriques, Guilherme Elias Pessanha; de Arruda Nóbilo, Mauro Antônio; Consani, Rafael Leonardo Xediek; Correr-Sobrinho, Lourenço; Mesquita, Marcelo Ferraz

2009-01-01

Objectives: This study evaluated the influence of prosthetic screw material on joint stability in implantsupported dentures at two levels of fit. Methods: Ten mandibular implant-supported dentures were fabricated. Twenty cast models were fabricated using these dentures. Four groups (n=10) were tested, according to the vertical fit of the dentures [passive and non-passive] and prosthetic screw materials [titanium (Ti) or gold (Au) alloy]. The one-screw test was performed to quantify the vertical misfits using an optic microscope. The loosening torque for the prosthetic screws was measured 24 hours after the tightening torque (10 Ncm) using a digital torque meter. Data were analyzed by two-way ANOVA and Tukey’s test (α=0.05). Results: Overall, dentures with passive fit and Ti screws resulted in significantly higher loosening torque of the prosthetic screws (p<0.05). No significant interaction was found between fit level and screw material (p=0.199). The prosthetic screw material and fit of implant-supported dentures have an influence on screw joint stability. Ti screws presented higher joint stability than Au screws and minimum of misfit should be found clinically to improve the mechanical behavior of the screw joint. PMID:20148135

Fatigue strength of common tibial intramedullary nail distal locking screws

PubMed Central

Griffin, Lanny V; Harris, Robert M; Zubak, Joseph J

2009-01-01

Background Premature failure of either the nail and/or locking screws with unstable fracture patterns may lead to angulation, shortening, malunion, and IM nail migration. Up to thirty percent of all unreamed nail locking screws can break after initial weight bearing is allowed at 8–10 weeks if union has not occurred. The primary problem this presents is hardware removal during revision surgery. The purposes of our study was to evaluate the relative fatigue resistance of distal locking screws and bolts from representative manufacturers of tibial IM nail systems, and develop a relative risk assessment of screws and materials used. Evaluations included quantitative and qualitative measures of the relative performance of these screws. Methods Fatigue tests were conducted to simulate a comminuted fracture that was treated by IM nailing assuming that all load was carried by the screws. Each screw type was tested ten times in a single screw configuration. One screw type was tested an additional ten times in a two-screw parallel configuration. Fatigue tests were performed using a servohydraulic materials testing system and custom fixturing that simulated screws placed in the distal region of an appropriately sized tibial IM nail. Fatigue loads were estimated based on a seventy-five kilogram individual at full weight bearing. The test duration was one million cycles (roughly one year), or screw fracture, whichever occurred first. Failure analysis of a representative sample of titanium alloy and stainless steel screws included scanning electron microscopy (SEM) and quantitative metallography. Results The average fatigue life of a single screw with a diameter of 4.0 mm was 1200 cycles, which would correspond roughly to half a day of full weight bearing. Single screws with a diameter of 4.5 mm or larger have approximately a 50 percent probability of withstanding a week of weight bearing, whereas a single 5.0 mm diameter screw has greater than 90 percent probability of withstanding more than a week of weight bearing. If two small diameter screws are used, our tests showed that the probability of withstanding a week of weight bearing increases from zero to about 20 percent, which is similar to having a single 4.5 mm diameter screw providing fixation. Conclusion Our results show that selecting the system that uses the largest distal locking screws would offer the best fatigue resistance for an unstable fracture pattern subjected to full weight bearing. Furthermore, using multiple screws will substantially reduce the risk of premature hardware failure. PMID:19371438

Pedicle Screw Insertion Accuracy Using O-Arm, Robotic Guidance, or Freehand Technique: A Comparative Study.

PubMed

Laudato, Pietro Aniello; Pierzchala, Katarzyna; Schizas, Constantin

2018-03-15

A retrospective radiological study. The aim of this study was to evaluate the accuracy of pedicle screw insertion using O-Arm navigation, robotic assistance, or a freehand fluoroscopic technique. Pedicle screw insertion using either "O-Arm" navigation or robotic devices is gaining popularity. Although several studies are available evaluating each of those techniques separately, no direct comparison has been attempted. Eighty-four patients undergoing implantation of 569 lumbar and thoracic screws were divided into three groups. Eleven patients (64 screws) had screws inserted using robotic assistance, 25 patients (191 screws) using the O-arm, while 48 patients (314 screws) had screws inserted using lateral fluoroscopy in a freehand technique. A single experienced spine surgeon assisted by a spinal fellow performed all procedures. Screw placement accuracy was assessed by two independent observers on postoperative computed tomography (CTs) according to the A to D Rampersaud criteria. No statistically significant difference was noted between the three groups. About 70.4% of screws in the freehand group, 69.6% in the O arm group, and 78.8% in the robotic group were placed completely within the pedicle margins (grade A) (P > 0.05). About 6.4% of screws were considered misplaced (grades C&D) in the freehand group, 4.2% in the O-arm group, and 4.7% in the robotic group (P > 0.05). The spinal fellow inserted screws with the same accuracy as the senior surgeon (P > 0.05). The advent of new technologies does not appear to alter accuracy of screw placement in our setting. Under supervision, spinal fellows might perform equally well to experienced surgeons using new tools. The lack of difference in accuracy does not imply that the above-mentioned techniques have no added advantages. Other issues, such as surgeon/patient radiation, fiddle factor, teaching suitability, etc., outside the scope of our present study, need further assessment. 3.

Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 4: Failure analysis of 10 fractured retaining screws retrieved from three patients.

PubMed

Al Jabbari, Youssef S; Fournelle, Raymond; Ziebert, Gerald; Toth, Jeffrey; Iacopino, Anthony M

2008-04-01

The aim of this study was to perform a failure analysis on fractured prosthetic retaining screws after long-term use in vivo. Additionally, the study addresses the commonly asked question regarding whether complex repeated functional occlusal forces initiate fatigue-type cracks in prosthetic retaining screws. Ten fractured prosthetic retaining screws retrieved from three patients treated with fixed detachable hybrid prostheses were subjected to a failure analysis. In patients 1 and 2, the middle three retaining screws of the prostheses were found fractured at retrieval time after they had been in service for 20 and 19 months, respectively. In patient 3, the middle three and one of the posterior retaining screws were found to be fractured at retrieval after they had been in service for 18 months. Low power stereomicroscopy and high-power scanning electron microscopy (SEM) were performed to analyze the fractured surfaces of the retaining screws examining fatigue cracks in greater detail. Typical fatigue failure characterized by ratchet mark formation was revealed by light microscopy and SEM for all examined screws. Using low magnification light microscopy, ratchet marks were visible on the fracture surfaces of only two screws. SEM examination revealed all three classical stages of fatigue failure, and it was possible to see the ratchet marks on the fracture surfaces of all specimens, indicating a fatigue zone. The final catastrophic overload fracture appeared fibrous, indicating ductile fracture. The final overload ductile fracture surfaces showed equiaxed dimples, suggesting tensile overload in all examined screws except in two specimens that showed an elongated dimple pattern indicating shear/tearing overload forces. Fracture of prosthetic retaining screws in hybrid prostheses occurs mainly through a typical fatigue mode involving mostly the middle anterior three screws. Fatigue cracks can grow in more than one prosthetic retaining screw, leading to fracture before the patient or clinician determines that any problem exists.

Finite Element Analysis of Osteosynthesis Screw Fixation in the Bone Stock: An Appropriate Method for Automatic Screw Modelling

PubMed Central

Wieding, Jan; Souffrant, Robert; Fritsche, Andreas; Mittelmeier, Wolfram; Bader, Rainer

2012-01-01

The use of finite element analysis (FEA) has grown to a more and more important method in the field of biomedical engineering and biomechanics. Although increased computational performance allows new ways to generate more complex biomechanical models, in the area of orthopaedic surgery, solid modelling of screws and drill holes represent a limitation of their use for individual cases and an increase of computational costs. To cope with these requirements, different methods for numerical screw modelling have therefore been investigated to improve its application diversity. Exemplarily, fixation was performed for stabilization of a large segmental femoral bone defect by an osteosynthesis plate. Three different numerical modelling techniques for implant fixation were used in this study, i.e. without screw modelling, screws as solid elements as well as screws as structural elements. The latter one offers the possibility to implement automatically generated screws with variable geometry on arbitrary FE models. Structural screws were parametrically generated by a Python script for the automatic generation in the FE-software Abaqus/CAE on both a tetrahedral and a hexahedral meshed femur. Accuracy of the FE models was confirmed by experimental testing using a composite femur with a segmental defect and an identical osteosynthesis plate for primary stabilisation with titanium screws. Both deflection of the femoral head and the gap alteration were measured with an optical measuring system with an accuracy of approximately 3 µm. For both screw modelling techniques a sufficient correlation of approximately 95% between numerical and experimental analysis was found. Furthermore, using structural elements for screw modelling the computational time could be reduced by 85% using hexahedral elements instead of tetrahedral elements for femur meshing. The automatically generated screw modelling offers a realistic simulation of the osteosynthesis fixation with screws in the adjacent bone stock and can be used for further investigations. PMID:22470474

Easy and Inexpensive Technique for Removal of Round Headed, Jammed Locking Screws in Distal Tibial Interlocking Plate.

PubMed

Singh, Harpreet; Sharma, Rohit; Gupta, Sachin; Singh, Narinderjit; Singh, Simarpreet

2015-01-01

The advent of locking plates has brought new problems in implant removal. Difficulty in removing screws from a locking plate is well-known. These difficulties include cold welding between the screw head and locking screw hole, stripping of the recess of the screw head for the screwdriver, and cross-threading between threads in the screw head and screw hole. However, there are cases in which removal is difficult. We describe a new technique for removing a round headed, jammed locking screws from a locking plate. 55 years old male patient received a locking distal tibial plate along with distal fibular plate 3years back from UAE. Now patient came with complaint of non-healing ulcer over medial aspect of lower 1/3rd of right leg from past 1 year. Non operative management did not improve the symptoms. The patient consented to implant removal, with the express understanding that implant removal might be impossible because already one failed attempt had been performed at some other hospital six months back. We then decided to proceed with the new technique. The rest of the proximal screws were removed using a technique not previously described. We used stainless steel metal cutting blades that are used to cut door locks or pad locks to cut the remaining stripped headed screws. This technique is very quick, easy to perform and inexpensive because the metal cutting blades which are used to cut the screws are very cheap. Yet it is very effective technique to remove the stripped headed or jammed locking screws. It is also very less destructive because of very less heat production during the procedure there is no problem of thermal necrosis to the bone or the surrounding soft tissue.

Screw joint stability after the application of retorque in implant-supported dentures under simulated masticatory conditions.

PubMed

Farina, Ana Paula; Spazzin, Aloísio Oro; Consani, Rafael Leonardo Xediek; Mesquita, Marcelo Ferraz

2014-06-01

Screws can loosen through mechanisms that have not been clearly established. The purpose of this study was to evaluate the influence of the tightening technique (the application of torque and retorque on the joint stability of titanium and gold prosthetic screws) in implant-supported dentures under different fit levels after 1 year of simulated masticatory function by means of mechanical cycling. Ten mandibular implant-supported dentures were fabricated, and 20 cast models were prepared by using the dentures to create 2 fit levels: passive fit and created misfit. The tightening protocol was evaluated according to 4 distinct profiles: without retorque plus titanium screws, without retorque plus gold screws, retorque plus titanium screws, and retorque plus gold screws. In the retorque application, the screws were tightened to 10 Ncm and retightened to 10 Ncm after 10 minutes. The screw joint stability after 1 year of simulated clinical function was measured with a digital torque meter. Data were analyzed statistically by 2-way ANOVA and Tukey honestly significant difference (HSD) post hoc tests (α=.05). The factors of fit level and tightening technique as well as the interaction between the factors, were statistically significant. The misfit decreases the loosening torque. The retorque application increased joint stability independent of fit level or screw material, which suggests that this procedure should be performed routinely during the tightening of these devices. All tightening techniques revealed reduced loosening torque values that were significantly lower in misfit dentures than in passive fit dentures. However, the retorque application significantly increased the loosening torque when titanium and gold screws were used. Therefore, this procedure should be performed routinely during screw tightening. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Composition and relative abundance of fish species in the lower White Salmon River, Washington, prior to the removal of Condit Dam

USGS Publications Warehouse

Allen, M. Brady; Connolly, Patrick J.

2011-01-01

Information about the composition and relative abundance of fish species was collected by a rotary screw trap and backpack electrofishing in the lower White Salmon River, Washington. The information was collected downstream of Condit Dam, which is at river kilometer (rkm) 5.2, and is proposed for removal in October 2011. A rotary screw trap was installed in the White Salmon River at rkm 1.5 and operated from March through June during 2006–09. All captured fish were identified to species and enumerated. Daily subsets of fish were weighed, measured, and fin clipped for a genetic analysis by the U.S. Fish and Wildlife Service.Fall Chinook salmon (Oncorhynchus tshawytscha) were captured in the highest numbers (n=18, 640), and were composed of two stocks: tule and upriver bright. Almost all captured fall Chinook salmon were age-0, with only 16 (0.09 percent) being age-1 or older.Tule fall Chinook salmon, the native stock, generally out-migrated from mid-March through early April. The tule stock was the more abundant fall Chinook salmon subspecies, comprising 85 percent of those captured in the trap.Upriver bright fall Chinook salmon comprised 15 percent of the Chinook salmon catch and generally out-migrated from late May to early June.Coho salmon ( kisutch) and steelhead trout (O. mykiss) were captured by the rotary screw trap in all years. Coho salmon were caught in low numbers (n=661) and 69 percent were age-0 fish. Steelhead were slightly more abundant (n=679) than coho salmon and 84 percent were age-1 or older fish.Trap efficiency estimates varied widely (range, 0-10 percent) by species, fish size, and time of year. However, if we use only the estimates from efficiency tests where more than 300 wild age-0 Chinook salmon were released, there was a mean trapping efficiency of 1.4 percent (n=4, median, 1.3 percent, range, 0.3–2.4 percent) during the tule out-migration period, and a mean trapping efficiency of 0.8 percent (n=2, range, 0.3–1.2 percent) during the upriver bright fall Chinook salmon out-migration period.When water levels in the White Salmon River declined in late summer, we electrofished the river margins in 2006–09 along three sites at rkm 1.5, 2.3, and 4.2. Age-0 steelhead were the most abundant fish captured (n=565, 62 percent), followed by age-0 coho salmon (n=222, 24 percent). In autumn, age-0 Chinook salmon were collected while electrofishing (n=40, 4 percent). This suggests that there may be a migration in the autumn as age-0 Chinook salmon or in the spring as age-1 Chinook salmon, since the Chinook salmon that migrate as age-0 fish in the spring departed several months earlier (the typical life history for fall Chinook salmon). The only age-1 salmonids captured while electrofishing were steelhead (n=84, 9 percent). Fish distribution and abundance will likely change when Condit Dam is removed and anadromous fish gain access to their historical spawning and rearing areas in the White Salmon River. These findings should provide a baseline with which to compare juvenile fish species composition and relative abundance after Condit Dam is removed.

The surgical learning curve and accuracy of minimally invasive lumbar pedicle screw placement using CT based computer-assisted navigation plus continuous electromyography monitoring - a retrospective review of 627 screws in 150 patients.

PubMed

Wood, Martin James; McMillen, Jason

2014-01-01

This study retrospectively assessed the accuracy of placement of lumbar pedicle screws placed by a single surgeon using a minimally-invasive, intra-operative CT-based computer navigated technique in combination with continuous electromyography (EMG) monitoring. The rates of incorrectly positioned screws were reviewed in the context of the surgeon's experience and learning curve. Data was retrospectively reviewed from all consecutive minimally invasive lumbar fusions performed by the primary author over a period of over 4 years from April 2008 until October 2012. All cases that had utilized computer-assisted intra-operative CT-based image guidance and continuous EMG monitoring to guide percutaneous pedicle screw placement were analysed for the rates of malposition of the pedicle screws. Pedicle screw malposition was defined as having occurred if the screw trajectory was adjusted intraoperatively due to positive EMG responses, or due to breach of the pedicle cortex by more than 2mm on intraoperative CT imaging performed at the end of the instrumentation procedure. Further analysis of the data was undertaken to determine if the rates of malposition changed with the surgeon's experience with the technique. Six hundred and twenty-seven pedicle screws were placed in one hundred and fifty patients. The overall rate of intraoperative malposition and subsequent adjustment of pedicle screw placement was 3.8% (24 of 627 screws). Screw malposition was detected by intraoperative CT imaging. Warning of potential screw misplacement was provided by use of the EMG monitoring. With increased experience with the technique, rates of intraoperative pedicle screw malposition were found to decrease from 5.1% of screws in the first fifty patients, to 2.0% in the last 50 patients. Only one screw was suboptimally placed at the end of surgery, which did not result in a neurological deficit. The use of CT-based computer-assisted navigation in combination with continuous EMG monitoring during percutaneous transpedicular screw placement results in very low rates of malposition and neural injury that compare favourably with previously reported rates. Pedicle screw placement accuracy continues to improve as the surgeon becomes more experienced with the technique.

The surgical learning curve and accuracy of minimally invasive lumbar pedicle screw placement using CT based computer-assisted navigation plus continuous electromyography monitoring – a retrospective review of 627 screws in 150 patients

PubMed Central

McMillen, Jason

2014-01-01

Objective This study retrospectively assessed the accuracy of placement of lumbar pedicle screws placed by a single surgeon using a minimally-invasive, intra-operative CT-based computer navigated technique in combination with continuous electromyography (EMG) monitoring. The rates of incorrectly positioned screws were reviewed in the context of the surgeon's experience and learning curve. Methods Data was retrospectively reviewed from all consecutive minimally invasive lumbar fusions performed by the primary author over a period of over 4 years from April 2008 until October 2012. All cases that had utilized computer-assisted intra-operative CT-based image guidance and continuous EMG monitoring to guide percutaneous pedicle screw placement were analysed for the rates of malposition of the pedicle screws. Pedicle screw malposition was defined as having occurred if the screw trajectory was adjusted intraoperatively due to positive EMG responses, or due to breach of the pedicle cortex by more than 2mm on intraoperative CT imaging performed at the end of the instrumentation procedure. Further analysis of the data was undertaken to determine if the rates of malposition changed with the surgeon's experience with the technique. Results Six hundred and twenty-seven pedicle screws were placed in one hundred and fifty patients. The overall rate of intraoperative malposition and subsequent adjustment of pedicle screw placement was 3.8% (24 of 627 screws). Screw malposition was detected by intraoperative CT imaging. Warning of potential screw misplacement was provided by use of the EMG monitoring. With increased experience with the technique, rates of intraoperative pedicle screw malposition were found to decrease from 5.1% of screws in the first fifty patients, to 2.0% in the last 50 patients. Only one screw was suboptimally placed at the end of surgery, which did not result in a neurological deficit. Conclusion The use of CT-based computer-assisted navigation in combination with continuous EMG monitoring during percutaneous transpedicular screw placement results in very low rates of malposition and neural injury that compare favourably with previously reported rates. Pedicle screw placement accuracy continues to improve as the surgeon becomes more experienced with the technique. PMID:25694919

Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system.

PubMed

Kaneyama, Shuichi; Sugawara, Taku; Sumi, Masatoshi

2015-03-15

Clinical trial for midcervical pedicle screw insertion using a novel patient-specific intraoperative screw guiding device. To evaluate the availability of the "Screw Guide Template" (SGT) system for insertion of midcervical pedicle screws. Despite many efforts for accurate midcervical pedicle screw insertion, there still remain unacceptable rate of screw malpositioning that might cause neurovascular injuries. We developed patient-specific SGT system for safe and accurate intraoperative screw navigation tool and have reported its availability for the screw insertion to C2 vertebra and thoracic spine. Preoperatively, the bone image on computed tomography was analyzed and the trajectories of the screws were designed in 3-dimensional format. Three types of templates were created for each lamina: location template, drill guide template, and screw guide template. During the operations, after engaging the templates directly with the laminae, drilling, tapping, and screwing were performed with each template. We placed 80 midcervical pedicle screws for 20 patients. The accuracy and safety of the screw insertion by SGT system were evaluated using postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw breach of pedicle wall. All templates fitted the laminae and screw navigation procedures proceeded uneventfully. All screws were inserted accurately with the mean screw deviation from planned trajectory of 0.29 ± 0.31 mm and no neurovascular complication was experienced. We demonstrated that our SGT system could support the precise screw insertion in midcervical pedicle. SGT prescribes the safe screw trajectory in a 3-dimensional manner and the templates fit and lock directly to the target laminae, which prevents screwing error along with the change of spinal alignment during the surgery. These advantages of the SGT system guarantee the high accuracy in screw insertion, which allowed surgeons to insert cervical pedicle screws safely. 3.

An efficient smolt trap for sandy and debris-laden streams

USGS Publications Warehouse

Scace, J.G.; Letcher, B.H.; Noreika, J.

2007-01-01

Tripod weir and box traps are traditionally used to capture and enumerate out-migrating salmonid smolts in short-term studies and in streams where temporary or portable traps are the only practical option. Although traditional traps can be effective when conditions are ideal, they are often unable to withstand high-discharge events in streams containing a large amount of debris or sandy substrates. We created a rotary-screw trap and resistance board weir hybrid design that we evaluated along with a tripod weir and box trap, both in a 6.1-m-wide flume and in the field. The new design outperformed the tripod weir in both situations. The tripod weir failed in 10 min in the flume trial, whereas the new design was still operating at the conclusion of an 8-h trial under the same conditions. The new design operated continuously in the field during a high-discharge event that caused the tripod weir to fail. The new design also required less frequent cleaning than the tripod weir. The trap efficiency of the new design was estimated by using passive integrated transponder (PIT) tag antennas and radiotelemetry. The trap was 80% efficient (n = 40) in capturing migrating PIT-tagged individuals detected at an antenna upstream of the trap and 87.5% efficient (n = 48) at recapturing fish that had been tagged and released upstream. With its high efficiency and increased resiliency over the tripod weir, the new trap design will benefit management and research efforts in streams where traditional traps are unsuitable. ?? Copyright by the American Fisheries Society 2007.

Measurement of Tip Apex Distance and Migration of Lag Screws and Novel Blade Screw Used for the Fixation of Intertrochanteric Fractures.

PubMed

Yang, Jesse Chieh-Szu; Chen, Hsin-Chang; Lai, Yu-Shu; Cheng, Cheng-Kung

2017-01-01

Fixation with a dynamic hip screw (DHS) is one of the most common methods for stabilizing intertrochanteric fractures, except for unstable and reverse oblique fracture types. However, failure is often observed in osteoporotic patients whereby the lag screw effectively 'cuts out' through the weak bone. Novel anti-migration blades have been developed to be used in combination with a lag screw ('Blade Screw') to improve the fixation strength in osteoporotic intertrochanteric fractures. An in-vitro biomechanical study and a retrospective clinical study were performed to evaluate lag screw migration when using the novel Blade Screw and a traditional threaded DHS. The biomechanical study showed both the Blade Screw and DHS displayed excessive migration (≥10 mm) before reaching 20,000 loading cycles in mild osteoporotic bone, but overall migration of the Blade Screw was significantly less (p ≤ 0.03). Among the patients implanted with a Blade Screw in the clinical study, there was no significant variation in screw migration at 3-months follow-up (P = 0.12). However, the patient's implanted with a DHS did display significantly greater migration (P<0.001) than those implanted with the Blade Screw. In conclusion, the Blade Screw stabilizes the bone fragments during dynamic loading so as to provide significantly greater resistance to screw migration in patients with mild osteoporosis.

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model.

PubMed

Kiyak, Gorkem; Balikci, Tevfik; Heydar, Ahmed Majid; Bezer, Murat

2018-02-01

Mechanical study. To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.

Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study.

PubMed

Hou, Yang; Lin, Yanping; Shi, Jiangang; Chen, Huajiang; Yuan, Wen

2018-03-14

The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training. To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study. A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach. The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05). The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.

Comparison of Expansive Pedicle Screw and Polymethylmethacrylate-Augmented Pedicle Screw in Osteoporotic Sheep Lumbar Vertebrae: Biomechanical and Interfacial Evaluations

PubMed Central

Zhang, Bo; Xie, Qing-yun; Wang, Cai-ru; Liu, Jin-biao; Liao, Dong-fa; Jiang, Kai; Lei, Wei; Pan, Xian-ming

2013-01-01

Background It was reported that expansive pedicle screw (EPS) and polymethylmethacrylate-augmented pedicle screw (PMMA-PS) could be used to increase screw stability in osteoporosis. However, there are no studies comparing the two kinds of screws in vivo. Thus, we aimed to compare biomechanical and interfacial performances of EPS and PMMA-PS in osteoporotic sheep spine. Methodology/Principal Findings After successful induction of osteoporotic sheep, lumbar vertebrae in each sheep were randomly divided into three groups. The conventional pedicle screw (CPS) was inserted directly into vertebrae in CPS group; PMMA was injected prior to insertion of CPS in PMMA-PS group; and the EPS was inserted in EPS group. Sheep were killed and biomechanical tests, micro-CT analysis and histological observation were performed at both 6 and 12 weeks post-operation. At 6-week and 12-week, screw stabilities in EPS and PMMA-PS groups were significantly higher than that in CPS group, but there were no significant differences between EPS and PMMA-PS groups at two study periods. The screw stability in EPS group at 12-week was significantly higher than that at 6-week. The bone trabeculae around the expanding anterior part of EPS were more and denser than that in CPS group at 6-week and 12-week. PMMA was found without any degradation and absorption forming non-biological “screw-PMMA-bone” interface in PMMA-PS group, however, more and more bone trabeculae surrounded anterior part of EPS improving local bone quality and formed biological “screw-bone” interface. Conclusions/Significance EPS can markedly enhance screw stability with a similar effect to the traditional method of screw augmentation with PMMA in initial surgery in osteoporosis. EPS can form better biological interface between screw and bone than PMMA-PS. In addition, EPS have no risk of thermal injury, leakage and compression caused by PMMA. We propose EPS has a great application potential in augmentation of screw stability in osteoporosis in clinic. PMID:24086381

What is the learning curve for robotic-assisted pedicle screw placement in spine surgery?

PubMed

Hu, Xiaobang; Lieberman, Isador H

2014-06-01

Some early studies with robotic-assisted pedicle screw implantation have suggested these systems increase accuracy of screw placement. However, the relationship between the success rate of screw placement and the learning curve of this new technique has not been evaluated. We determined whether, as a function of surgeon experience, (1) the success rate of robotic-assisted pedicle screw placement improved, (2) the frequency of conversion from robotic to manual screw placement decreased, and (3) the frequency of malpositioned screws decreased. Between June 2010 and August 2012, the senior surgeon (IHL) performed 174 posterior spinal procedures using pedicle screws, 162 of which were attempted with robotic assistance. The use of the robotic system was aborted in 12 of the 162 procedures due to technical issues (registration failure, software crash, etc). The robotic system was successfully used in the remaining 150 procedures. These were the first procedures performed with the robot by the senior surgeon, and in this study, we divided the early learning curve into five groups: Group 1 (Patients 1-30), Group 2 (Patients 31-60), Group 3 (Patients 61-90), Group 4 (Patients 91-120), and Group 5 (Patients 121-150). One hundred twelve patients (75%) had spinal deformity and 80 patients (53%) had previous spine surgery. The accuracy of screw placement in the groups was assessed based on intraoperative biplanar fluoroscopy and postoperative radiographs. The results from these five groups were compared to determine the effect on the learning curve. The numbers of attempted pedicle screw placements were 359, 312, 349, 359, and 320 in Groups 1 to 5, respectively. The rates of successfully placed screws using robotic guidance were 82%, 93%, 91%, 95%, and 93% in Groups 1 to 5. The rates of screws converted to manual placement were 17%, 7%, 8%, 4%, and 7%. Of the robotically placed screws, the screw malposition rates were 0.8%, 0.3%, 1.4%, 0.8%, and 0%. The rate of successfully placed pedicle screws improved with increasing experience. The rate of the screws that were converted to manual placement decreased with increasing experience. The frequency of screw malposition was similar over the learning curve at 0% to 1.4%. Future studies will need to determine whether this finding is generalizable to others. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

In-vitro development of a temporal abutment screw to protect osseointegration in immediate loaded implants.

PubMed

García-Roncero, Herminio; Caballé-Serrano, Jordi; Cano-Batalla, Jordi; Cabratosa-Termes, Josep; Figueras-Álvarez, Oscar

2015-04-01

In this study, a temporal abutment fixation screw, designed to fracture in a controlled way upon application of an occlusal force sufficient to produce critical micromotion was developed. The purpose of the screw was to protect the osseointegration of immediate loaded single implants. Seven different screw prototypes were examined by fixing titanium abutments to 112 Mozo-Grau external hexagon implants (MG Osseous®; Mozo-Grau, S.A., Valladolid, Spain). Fracture strength was tested at 30° in two subgroups per screw: one under dynamic loading and the other without prior dynamic loading. Dynamic loading was performed in a single-axis chewing simulator using 150,000 load cycles at 50 N. After normal distribution of obtained data was verified by Kolmogorov-Smirnov test, fracture resistance between samples submitted and not submitted to dynamic loading was compared by the use of Student's t-test. Comparison of fracture resistance among different screw designs was performed by the use of one-way analysis of variance. Confidence interval was set at 95%. Fractures occurred in all screws, allowing easy retrieval. Screw Prototypes 2, 5 and 6 failed during dynamic loading and exhibited statistically significant differences from the other prototypes. Prototypes 2, 5 and 6 may offer a useful protective mechanism during occlusal overload in immediate loaded implants.

Thermodynamic performance of multi-stage gradational lead screw vacuum pump

NASA Astrophysics Data System (ADS)

Zhao, Fan; Zhang, Shiwei; Sun, Kun; Zhang, Zhijun

2018-02-01

As a kind of dry mechanical vacuum pump, the twin-screw vacuum pump has an outstanding pumping performance during operation, widely used in the semiconductor industry. Compared with the constant lead screw (CLS) vacuum pump, the gradational lead screw (GLS) vacuum pump is more popularly applied in recent years. Nevertheless, not many comparative studies on the thermodynamic performance of GLS vacuum pump can be found in the literature. Our study focuses on one type of GLS vacuum pump, the multi-stage gradational lead screw (MGLS) vacuum pump, gives a detailed description of its construction and illustrates it with the drawing. Based on the structural analysis, the thermodynamic procedure is divided into four distinctive processes, including sucking process, transferring (compressing) process, backlashing process and exhausting process. The internal mechanism of each process is qualitatively illustrated and the mathematical expressions of seven thermodynamic parameters are given under the ideal situation. The performance curves of MGLS vacuum pump are plotted by MATLAB software and compared with those of the CLS vacuum pump in the same case. The results can well explain why the MGLS vacuum pump has more favorable pumping performance than the CLS vacuum pump in saving energy, reducing noise and heat dissipation.

THE INFLUENCE OF SCREW TYPE, ALLOY AND CYLINDER POSITION ON THE MARGINAL FIT OF IMPLANT FRAMEWORKS BEFORE AND AFTER LASER WELDING

PubMed Central

Castilio, Daniela; Pedreira, Ana Paula Ribeiro do Vale; Rossetti, Paulo Henrique Orlato; Rossetti, Leylha Maria Nunes; Bonachela, Wellington Cardoso

2006-01-01

Misfit at the abutment-prosthetic cylinder interface can cause loss of preload, leading to loosening or fracture of gold and titanium screws. Objectives: To evaluate the influence of screw type, alloy, and cylinder position on marginal fit of implant frameworks before and after laser welding. Methods: After Estheticone-like abutments were screwed to the implants, thirty plastic prosthetic cylinders were mounted and waxed-up to fifteen cylindrical bars. Each specimen had three interconnected prosthetic components. Five specimens were one-piece cast in titanium and five in cobalt-chromium alloy. On each specimen, tests were conducted with hexagonal titanium and slotted gold screws separately, performing a total of thirty tested screws. Measurements at the interfaces were performed using an optical microscope with 5 μm accuracy. After sectioning, specimens were laser welded and new measurements were obtained. Data were submitted to a four-way ANOVA and Tukey's multiple comparisons test (α =0.05). Results: Slotted and hexagonal screws did not present significant differences regarding to the fit of cylinders cast in titanium, either in one-piece casting framework or after laser welding. When slotted and hexagonal screws were tested on the cobalt-chromium specimens, statistically significant differences were found for the one-piece casting condition, with the slotted screws presenting better fit (24.13μm) than the hexagonal screws (27.93 μm). Besides, no statistically significant differences were found after laser welding. Conclusions: 1) The use of different metal alloys do exert influence on the marginal fit, 2) The slotted and hexagonal screws play the exclusive role of fixing the prosthesis, and did not improve the fit of cylinders, and 3) cylinder position did not affect marginal fit values. PMID:19089035

The influence of screw type, alloy and cylinder position on the marginal fit of implant frameworks before and after laser welding.

PubMed

Castilio, Daniela; Pedreira, Ana Paula Ribeiro do Vale; Rossetti, Paulo Henrique Orlato; Rossetti, Leylha Maria Nunes; Bonachela, Wellington Cardoso

2006-04-01

Misfit at the abutment-prosthetic cylinder interface can cause loss of preload, leading to loosening or fracture of gold and titanium screws. To evaluate the influence of screw type, alloy, and cylinder position on marginal fit of implant frameworks before and after laser welding. After Estheticone-like abutments were screwed to the implants, thirty plastic prosthetic cylinders were mounted and waxed-up to fifteen cylindrical bars. Each specimen had three interconnected prosthetic components. Five specimens were one-piece cast in titanium and five in cobalt-chromium alloy. On each specimen, tests were conducted with hexagonal titanium and slotted gold screws separately, performing a total of thirty tested screws. Measurements at the interfaces were performed using an optical microscope with 5mm accuracy. After sectioning, specimens were laser welded and new measurements were obtained. Data were submitted to a four-way ANOVA and Tukey's multiple comparisons test (alpha=0.05). Slotted and hexagonal screws did not present significant differences regarding to the fit of cylinders cast in titanium, either in one-piece casting framework or after laser welding. When slotted and hexagonal screws were tested on the cobalt-chromium specimens, statistically significant differences were found for the one-piece casting condition, with the slotted screws presenting better fit (24.13 microm) than the hexagonal screws (27.93 microm). Besides, no statistically significant differences were found after laser welding. 1) The use of different metal alloys do exert influence on the marginal fit, 2) The slotted and hexagonal screws play the exclusive role of fixing the prosthesis, and did not improve the fit of cylinders, and 3) cylinder position did not affect marginal fit values.

In vitro and in vivo studies on the degradation of high-purity Mg (99.99wt.%) screw with femoral intracondylar fractured rabbit model.

PubMed

Han, Pei; Cheng, Pengfei; Zhang, Shaoxiang; Zhao, Changli; Ni, Jiahua; Zhang, Yuanzhuang; Zhong, Wanrun; Hou, Peng; Zhang, Xiaonong; Zheng, Yufeng; Chai, Yimin

2015-09-01

High-purity magnesium (HP Mg) takes advantage in no alloying toxic elements and slower degradation rate in lack of second phases and micro-galvanic corrosion. In this study, as rolled HP Mg was fabricated into screws and went through in vitro immersion tests, cytotoxicity test and bioactive analysis. The HP Mg screws performed uniform corrosion behavior in vitro, and its extraction promoted cell viability, bone alkaline phosphatase (ALP) activity, and mRNA expression of osteogenic differentiation related gene, i.e. ALP, osteopontin (OPN) and RUNX2 of human bone marrow mesenchymal stem cells (hBMSCs). Then HP Mg screws were implanted in vivo as load-bearing implant to fix bone fracture and subsequently gross observation, range of motion (ROM), X-ray scanning, qualitative micro-computed tomography (μCT) analysis, histological analysis, bending-force test and SEM morphology of retrieved screws were performed respectively at 4, 8, 16 and 24 weeks. As a result, the retrieved HP Mg screws in fixation of rabbit femoral intracondylar fracture showed uniform degradation morphology and enough bending force. However, part of PLLA screws was broken in bolt, although its screw thread was still intact. Good osseointegration was revealed surrounding HP Mg screws and increased bone volume and bone mineral density were detected at fracture gap, indicating the rigid fixation and enhanced fracture healing process provided by HP Mg screws. Consequently, the HP Mg showed great potential as internal fixation devices in intra-articular fracture operation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Biomechanical and histological evaluation of an expandable pedicle screw in osteoporotic spine in sheep

PubMed Central

Wan, Shiyong; Wu, Zixiang; Liu, Da; Gao, Mingxuan; Fu, Suochao

2010-01-01

Transpedicular fixation can be challenging in the osteoporotic spine as reduced bone mineral density compromises the mechanical stability of the pedicle screw. Here, we sought to investigate the biomechanical and histological properties of stabilization of expandable pedicle screw (EPS) in the osteoporotic spine in sheep. EPSs and standard pedicle screws, SINO screws, were inserted on the vertebral bodies in four female ovariectomized sheep. Pull-out and cyclic bending resistance test were performed to compare the holding strength of these pedicle screws. High-resolution micro-computed tomography (CT) was performed for three-dimensional image reconstruction. We found that the EPSs provided a 59.6% increase in the pull-out strength over the SINO screws. Moreover, the EPSs withstood a greater number of cycles or load with less displacement before loosening. Micro-CT image reconstruction showed that the tissue mineral density, bone volume fraction, bone surface/bone volume ratio, trabecular thickness, and trabecular separation were significantly better in the expandable portion of the EPSs than those in the anterior portion of the SINO screws (P < 0.05). Furthermore, the trabecular architecture in the screw–bone interface was denser in the expandable portion of the EPS than that in the anterior portion of the SINO screw. Histologically, newly formed bone tissues grew into the center of EPS and were in close contact with the EPS. Our results show that the EPS demonstrates improved biomechanical and histological properties over the standard screw in the osteoporotic spine. The EPS may be of value in treating patients with osteoporosis and warrants further clinical studies. PMID:20577766

Torque removal evaluation of prosthetic screws after tightening and loosening cycles: an in vitro study.

PubMed

Cardoso, Mayra; Torres, Marcelo Ferreira; Lourenço, Eduardo José Veras; de Moraes Telles, Daniel; Rodrigues, Renata Cristina Silveira; Ribeiro, Ricardo Faria

2012-04-01

The aim of this study was to evaluate the variation in removal torque of implant prosthetic abutment screws after successive tightening and loosening cycles, in addition to evaluating the influence of the hexagon at the abutment base on screw removal torque. Twenty hexagonal abutments were tightened to 20 regular external hex implants with a titanium alloy screw, with an insertion torque of 32 N cm, measured with a digital torque gauge. The implant/abutment/screw assemblies were divided into two groups: (1) abutments without hexagon at the base and (2) abutments with a hexagon at the base. Each assembly received a provisional restoration and was submitted to mechanical loading cycles. After this, the screws were removed and the removal torque was measured. This sequence was repeated 10 times, then the screw was replaced by a new one, and another cycle was performed. Linear regression analysis was performed. Removal torque values tended to decrease as the number of insertion/removal cycles increased, for both groups. Comparisons of the slopes and the intercepts between groups showed no statistical difference. There was no significant difference between the mean values of last five cycles and the 11th cycle. Within the limitations of this in vitro study, it was concluded that (1) repeated insertion/removal cycles promoted gradual reduction in removal torque of screws, (2) replacing the screw with a new one after 10 cycles did not increase resistance to loosening, and (3) removal of the hexagon from the abutment base had no effect on the removal torque of the screws. © 2011 John Wiley & Sons A/S.

Internally Heated Screw Pyrolysis Reactor (IHSPR) heat transfer performance study

NASA Astrophysics Data System (ADS)

Teo, S. H.; Gan, H. L.; Alias, A.; Gan, L. M.

2018-04-01

1.5 billion end-of-life tyres (ELT) were discarded globally each year and pyrolysis is considered the best solution to convert the ELT into valuable high energy-density products. Among all pyrolysis technologies, screw reactor is favourable. However, conventional screw reactor risks plugging issue due to its lacklustre heat transfer performance. An internally heated screw pyrolysis reactor (IHSPR) was developed by local renewable energy industry, which serves as the research subject for heat transfer performance study of this particular paper. Zero-load heating test (ZLHT) was first carried out to obtain the operational parameters of the reactor, followed by the one dimensional steady-state heat transfer analysis carried out using SolidWorks Flow Simulation 2016. Experiments with feed rate manipulations and pyrolysis products analyses were conducted last to conclude the study.

Percutaneous computer-assisted translaminar facet screw: an initial human cadaveric study.

PubMed

Sasso, Rick C; Best, Natalie M; Potts, Eric A

2005-01-01

Translaminar facet screws are a minimally invasive technique for posterior lumbar fixation with good success rates. Computer-assisted image navigation using virtual fluoroscopy allows multiple simultaneous screens in various planes to plan and drive spinal instrumentation. This study evaluates the percutaneous placement of translaminar facet screws with the use of virtual fluoroscopy as an image guidance technique. A human cadaveric study was performed with a percutaneous reference frame applied to the iliac crest. Ten translaminar facet screws were placed bilaterally at five levels. Anteroposterior and lateral images were used to navigate 4.0-mm screws through a percutaneous portal under virtual fluoroscopy. An axial computed tomographic scan through the instrumented levels was obtained after the screws were placed. Screws were graded on entry, course through the lamina, and terminus. A grading system was devised to grade the course through the lamina. All 10 screw-entry points were judged optimal at the spinous process laminar junction. There were five Grade I breeches with less than 1/2 the screw through the lamina, and five Grade 0 screw placements with the screw contained completely within the lamina. The termination point was acceptable in five screws. The screws that began on the right and terminated on the left were all found to have grade II breakouts. No screws placed the spinal canal or exiting nerve root at risk. Virtual fluoroscopy provides significant assistance in percutaneous placement of translaminar facet screws and results in safe position of entry, lamina course, and terminus.

The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

PubMed Central

Karaarslan, Ahmet A; Karakaşli, Ahmet; Aycan, Hakan; Çeçen, Berivan; Yildiz, Didem Venüs; Sesli, Erhan

2016-01-01

Background: Proximal locking screw deformation and screw fracture is a frequently seen problem for femur interlocking nailing that affects fracture healing. We realized that there is lack of literature for the right level for the proximal locking screw. We investigated the difference of locking screw bending resistance between the application of screws on different proximal femoral levels. Materials and Methods: We used a total of 80 proximal locking screws for eight groups, 10 screws for each group. Three-point bending tests were performed on four types of screws in two different trochanteric levels (the lesser trochanter and 20 mm proximal). We determined the yield points at three-point bending tests that a permanent deformation started in the locking screws using an axial compression testing machine. Results: The mean yield point value of 5 mm threaded locking screws applied 20 mm proximal of lesser trochanter was 1022 ± 49 (range 986–1057) (mean ± standard deviation, 95% confidence interval). On the other hand, the mean yield point value of the same type of locking screws applied on the lesser trochanteric level was 2089 ± 249 (range 1911–2268). Which means 103% increase of screw resistance between two levels (P = 0.000). In all screw groups, on the lesser trochanter line we determined 98–174% higher than the yield point values of the same type of locking screws in comparison with 20 mm proximal to the lesser trochanter (P = 0.000). Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures. PMID:26955183

Do screws and screw holes affect osteolysis in cementless cups using highly crosslinked polyethylene? A 7 to 10-year follow-up case-control study.

PubMed

Taniguchi, N; Jinno, T; Takada, R; Koga, D; Ando, T; Okawa, A; Haro, H

2018-05-01

The use of screws and the presence of screw holes may cause acetabular osteolysis and implant loosening in cementless total hip arthroplasty (THA) using conventional polyethylene. In contrast, this issue is not fully understood using highly crosslinked polyethylene (HXLPE), particularly in large comparative study. Therefore, we performed a case-control study to assess the influence of screw usage and screw holes on: (1) implant fixation and osteolysis and (2) polyethylene steady-state wear rate, using cases with HXLPE liners followed up for 7-10 years postoperatively. The screw usage and screw holes adversely affect the implant fixation and incidence of wear-related osteolysis in THA with HXLPE. We reviewed 209 primary cementless THAs performed with 26-mm cobalt-chromium heads on HXLPE liners. To compare the effects of the use of screws and the presence of screw holes, the following groups were established: (1) with-screw (n=140); (2) without-screw (n=69); (3) no-hole (n=27) and (4) group in which a cup with screw holes, but no screw was used (n=42). Two adjunct groups (no-hole cups excluded) were established to compare the differences in the two types of HXLPE: (5) remelted group (n=100) and (6) annealed group (n=82). Implant stability and osteolysis were evaluated by plain radiography and computed tomography. The wear rate from 1 year to the final evaluation was measured using plain X-rays and PolyWare Digital software. All cups and stems achieved bony fixation. On CT-scan, no acetabular osteolysis was found, but there were 3 cases with a small area of femoral osteolysis. The mean steady-state wear rate of each group was (1) 0.031±0.022, (2) 0.033±0.035, (3) 0.031±0.024, (4) 0.029±0.018, (5) 0.030±0.018 and (6) 0.034±0.023mm/year, respectively. A comparison of the effects of screw usage or screw holes found no significant between-group differences in the implant stability, prevalence of osteolysis [no acetabular osteolysis and 3/209 at femoral side (1.4%)] and steady-state wear rate. This study suggests that there are no adverse effects on the results of THA with HXLPE from the use of cups with screw holes and the use of screws for cup fixation. Level III retrospective case-control study. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Lateral Movement of Screw Dislocations During Homoepitaxial Growth and Devices Yielded Therefrom Free of the Detrimental Effects of Screw Dislocations

NASA Technical Reports Server (NTRS)

Neudeck, Philip G. (Inventor); Powell, J. Anthony (Inventor)

2004-01-01

The present invention is related to a method that enables and improves wide bandgap homoepitaxial layers to be grown on axis single crystal substrates, particularly SiC. The lateral positions of the screw dislocations in epitaxial layers are predetermined instead of random, which allows devices to be reproducibly patterned to avoid performance degrading crystal defects normally created by screw dislocations.

Bacteria exploit a polymorphic instability of the flagellar filament to escape from traps.

PubMed

Kühn, Marco J; Schmidt, Felix K; Eckhardt, Bruno; Thormann, Kai M

2017-06-13

Many bacterial species swim by rotating single polar helical flagella. Depending on the direction of rotation, they can swim forward or backward and change directions to move along chemical gradients but also to navigate their obstructed natural environment in soils, sediments, or mucus. When they get stuck, they naturally try to back out, but they can also resort to a radically different flagellar mode, which we discovered here. Using high-speed microscopy, we monitored the swimming behavior of the monopolarly flagellated species Shewanella putrefaciens with fluorescently labeled flagellar filaments at an agarose-glass interface. We show that, when a cell gets stuck, the polar flagellar filament executes a polymorphic change into a spiral-like form that wraps around the cell body in a spiral-like fashion and enables the cell to escape by a screw-like backward motion. Microscopy and modeling suggest that this propagation mode is triggered by an instability of the flagellum under reversal of the rotation and the applied torque. The switch is reversible and bacteria that have escaped the trap can return to their normal swimming mode by another reversal of motor direction. The screw-type flagellar arrangement enables a unique mode of propagation and, given the large number of polarly flagellated bacteria, we expect it to be a common and widespread escape or motility mode in complex and structured environments.

Torsional stability of interference screws derived from bovine bone - a biomechanical study

PubMed Central

2010-01-01

Background In the present biomechanical study, the torsional stability of different interference screws, made of bovine bone, was tested. Interference screws derived from bovine bone are a possible biological alternative to conventional metallic or bioabsorbable polymer interference screws. Methods In the first part of the study we compared the torsional stability of self-made 8 mm Interference screws (BC) and a commercial 8 mm interference screw (Tutofix®). Furthermore, we compared the torsional strength of BC screws with different diameters. For screwing in, a hexagon head and an octagon head were tested. Maximum breaking torques in polymethyl methacrylate resin were recorded by means of an electronic torque screw driver. In the second part of the study the tibial part of a bone-patellar tendon-bone graft was fixed in porcine test specimens using an 8 mm BC screw and the maximum insertion torques were recorded. Each interference screw type was tested 5 times. Results There was no statistically significant difference between the different 8 mm interference screws (p = 0.121). Pairwise comparisons did not reveal statistically significant differences, either. It was demonstrated for the BC screws, that a larger screw diameter significantly leads to higher torsional stability (p = 9.779 × 10-5). Pairwise comparisons showed a significantly lower torsional stability for the 7 mm BC screw than for the 8 mm BC screw (p = 0.0079) and the 9 mm BC screw (p = 0.0079). Statistically significant differences between the 8 mm and the 9 mm BC screw could not be found (p = 0.15). During screwing into the tibial graft channel of the porcine specimens, insertion torques between 0.5 Nm and 3.2 Nm were recorded. In one case the hexagon head of a BC screw broke off during the last turn. Conclusions The BC screws show comparable torsional stability to Tutofix® interference screws. As expected the torsional strength of the screws increases significantly with the diameter. The safety and in vivo performance of products derived from xenogeneic bone should be the focus of further investigations. PMID:20433761

Validity of computed tomography in predicting scaphoid screw prominence: a cadaveric study.

PubMed

Griffis, Clare E; Olsen, Cara; Nesti, Leon; Gould, C Frank; Frew, Michael; McKay, Patricia

2017-04-01

Studies of hardware protrusion into joint spaces following fracture fixation have been performed to address whether or not there is discrepancy between the actual and radiographic appearance of screw prominence. The purpose of our study was to prove that, with respect to the scaphoid, prominence as visualized on CT scan is real and not a result of metal artifact. Forty-two cadaveric wrists were separated into four allotted groups with 21 control specimens and 21 study specimens. All specimens were radiographically screened to exclude those with inherent carpal abnormalities. Acutrak® headless compression screws were placed into all specimens using an open dorsal approach. Cartilage was removed from screw insertion site at the convex surface of the scaphoid proximal pole. Control specimens had 0 mm screw head prominence. The studied specimens had 1, 2, and 3 mm head prominence measured with a digital caliper. Computed tomography, with direct sagittal acquisition and metal suppression technique, was then performed on all specimens following screw placement. Two staff radiologists blinded to the study groups interpreted the images. Results revealed that only one of 21 control specimens was interpreted as prominent. Comparatively, in the studied groups, 90% were accurately interpreted as prominent. CT provides an accurate assessment of scaphoid screw head prominence. When a screw appears prominent on CT scan, it is likely to be truly prominent without contribution from metallic artifact.

In-vitro development of a temporal abutment screw to protect osseointegration in immediate loaded implants

PubMed Central

2015-01-01

PURPOSE In this study, a temporal abutment fixation screw, designed to fracture in a controlled way upon application of an occlusal force sufficient to produce critical micromotion was developed. The purpose of the screw was to protect the osseointegration of immediate loaded single implants. MATERIALS AND METHODS Seven different screw prototypes were examined by fixing titanium abutments to 112 Mozo-Grau external hexagon implants (MG Osseous®; Mozo-Grau, S.A., Valladolid, Spain). Fracture strength was tested at 30° in two subgroups per screw: one under dynamic loading and the other without prior dynamic loading. Dynamic loading was performed in a single-axis chewing simulator using 150,000 load cycles at 50 N. After normal distribution of obtained data was verified by Kolmogorov-Smirnov test, fracture resistance between samples submitted and not submitted to dynamic loading was compared by the use of Student's t-test. Comparison of fracture resistance among different screw designs was performed by the use of one-way analysis of variance. Confidence interval was set at 95%. RESULTS Fractures occurred in all screws, allowing easy retrieval. Screw Prototypes 2, 5 and 6 failed during dynamic loading and exhibited statistically significant differences from the other prototypes. CONCLUSION Prototypes 2, 5 and 6 may offer a useful protective mechanism during occlusal overload in immediate loaded implants. PMID:25932315

Effect of Repeated Screw Joint Closing and Opening Cycles and Cyclic Loading on Abutment Screw Removal Torque and Screw Thread Morphology: Scanning Electron Microscopy Evaluation.

PubMed

Arshad, Mahnaz; Mahgoli, Hosseinali; Payaminia, Leila

To evaluate the effect of repeated screw joint closing and opening cycles and cyclic loading on abutment screw removal torque and screw thread morphology using scanning electron microscopy (SEM). Three groups (n = 10 in each group) of implant-abutment-abutment screw assemblies were created. There were also 10 extra abutment screws as new screws in group 3. The abutment screws were tightened to 12 Ncm with an electronic torque meter; then they were removed and removal torque values were recorded. This sequence was repeated 5 times for group 1 and 15 times for groups 2 and 3. The same screws in groups 1 and 2 and the new screws in group 3 were then tightened to 12 Ncm; this was also followed by screw tightening to 30 Ncm and retightening to 30 Ncm 15 minutes later. Removal torque measurements were performed after screws were subjected to cyclic loading (0.5 × 10⁶ cycles; 1 Hz; 75 N). Moreover, the surface topography of one screw from each group before and after cyclic loading was evaluated with SEM and compared with an unused screw. All groups exhibited reduced removal torque values in comparison to insertion torque in each cycle. However, there was a steady trend of torque loss in each group. A comparison of the last cycle of the groups before loading showed significantly greater torque loss value in the 15th cycle of groups 2 and 3 compared with the fifth cycle of group 1 (P < .05). Nonetheless, torque loss values after loading were not shown to be significantly different from each other. Using a new screw could not significantly increase the value of removal torque. It was concluded that restricting the amount of screw tightening is more important than replacing the screw with a new one when an abutment is definitively placed.

Feasibility of translaminar screw placement in Korean population: morphometric analysis of cervical spine.

PubMed

Ji, Gyu Yeul; Oh, Chang Hyun; Park, Sang Hyuk; Kurniawan, Ferry; Lee, Junho; Jeon, Jae Kyun; Shin, Dong Ah; Kim, Keung Nyun

2015-01-01

To analyze the feasibility of unilateral and bilateral translaminar screw placement in Koran population, and compare the acceptance rate using previously reported data in American population. The translaminar lengths, thickness, heights, and sagittal-diagonal measurements were performed. The feasibility analysis was performed using unilateral and bilateral 3.5 mm cervical screw placement on the CT scans within 0.5 mm of safety margin. We also performed radiographic analysis of the morphometric dimensions and the feasibility of unilateral and bilateral translaminar screw placement at C3-C7. Korean population had similar or significantly shorter translaminar lengths and thickness (lengths and thickness in C7 among males; lengths in C6-C7 and thickness in C4 among females) than American population, but had similar or significantly longer translaminar heights and sagittal-diagonal measurements (heights in C3-C7 and sagittal-diagonal measurements in C3-C6 among males; heights in C7 and sagittal-diagonal measurements in C3-C7 among females). Unilaterally, translaminar screw acceptance rates in C3-C7 were similar between Korean and American male population, but the rates in C4-C6 were significantly smaller between Korean and American female population. Bilaterally, translaminar screw acceptance rates in C3 and C5-C6 were significantly larger between Korean and American male population, but the rates in C3-C7 were similar between Korean and American female population. The feasibility of unilateral and bilateral translaminar screw placement is different depending on different ethnics. Subaxial cervical unilateral translaminar screw placement among Korean male population and bilateral placement at C4-C7 among Korean female population are more acceptable than American population.

Comparing conventional and computer-assisted surgery baseplate and screw placement in reverse shoulder arthroplasty.

PubMed

Venne, Gabriel; Rasquinha, Brian J; Pichora, David; Ellis, Randy E; Bicknell, Ryan

2015-07-01

Preoperative planning and intraoperative navigation technologies have each been shown separately to be beneficial for optimizing screw and baseplate positioning in reverse shoulder arthroplasty (RSA) but to date have not been combined. This study describes development of a system for performing computer-assisted RSA glenoid baseplate and screw placement, including preoperative planning, intraoperative navigation, and postoperative evaluation, and compares this system with a conventional approach. We used a custom-designed system allowing computed tomography (CT)-based preoperative planning, intraoperative navigation, and postoperative evaluation. Five orthopedic surgeons defined common preoperative plans on 3-dimensional CT reconstructed cadaveric shoulders. Each surgeon performed 3 computer-assisted and 3 conventional simulated procedures. The 3-dimensional CT reconstructed postoperative units were digitally matched to the preoperative model for evaluation of entry points, end points, and angulations of screws and baseplate. Values were used to find accuracy and precision of the 2 groups with respect to the defined placement. Statistical analysis was performed by t tests (α = .05). Comparison of the groups revealed no difference in accuracy or precision of screws or baseplate entry points (P > .05). Accuracy and precision were improved with use of navigation for end points and angulations of 3 screws (P < .05). Accuracy of the inferior screw showed a trend of improvement with navigation (P > .05). Navigated baseplate end point precision was improved (P < .05), with a trend toward improved accuracy (P > .05). We conclude that CT-based preoperative planning and intraoperative navigation allow improved accuracy and precision for screw placement and precision for baseplate positioning with respect to a predefined placement compared with conventional techniques in RSA. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

BIOMECHANICAL EVALUATION OF THE INFLUENCE OF CERVICAL SCREWS TAPPING AND DESIGN.

PubMed

Silva, Patricia; Rosa, Rodrigo César; Shimano, Antonio Carlos; Albuquerque de Paula, Francisco José; Volpon, José Batista; Aparecido Defino, Helton Luiz

2009-01-01

To assess if the screw design (self-drilling/self-tapping) and the pilot hole tapping could affect the insertion torque and screw pullout strength of the screw used in anterior fixation of the cervical spine. Forty self-tapping screws and 20 self-drilling screws were inserted into 10 models of artificial bone and 10 cervical vertebrae of sheep. The studied parameters were the insertion torque and pullout strength. The following groups were created: Group I-self-tapping screw insertion after pilot hole drilling and tapping; Group II-self-tapping screw insertion after pilot hole drilling without tapping; Group III-self-drilling screw insertion without drilling and tapping. In Groups I and II, the pilot hole had 14.0 mm in depth and was made with a 3mmn drill, while tapping was made with a 4mm tap. The insertion torque was measured and the pullout test was performed. The comparison between groups was made considering the mean insertion torque and the maximum mean pullout strength with the variance analysis (ANOVA; p≤ 0.05). Previous drilling and tapping of pilot hole significantly decreased the insertion torque and the pullout strength. The insertion torque and pullout strength of self-drilling screws were significantly higher when compared to self-tapping screws inserted after pilot hole tapping.

The effect of different screw-rod design on the anti-rotational torque: a biomechanical comparison of three conventional screw-rod constructs.

PubMed

Huang, Zifang; Wang, Chongwen; Fan, Hengwei; Sui, Wenyuan; Li, Xueshi; Wang, Qifei; Yang, Junlin

2017-07-28

Screw-rod constructs have been widely used to correct spinal deformities, but the effects of different screw-rod systems on anti-rotational torque have not been determined. This study aimed to analyze the biomechanical effect of different rod-screw constructs on anti-rotational torque. Three conventional spinal screw-rod systems (Legacy, RF-F-10 and USSII) were used to test the anti-rotational torque in the material test machine. ANOVA was performed to evaluate the anti-rotational capacity of different pedicle screws-rod constructs. The anti-rotational torque of Legacy group, RF-F-10 group and USSII group were 12.3 ± 1.9 Nm, 6.8 ± 0.4 Nm, and 3.9 ± 0.8 Nm, with a P value lower than 0.05. This results indicated that the Legacy screws-rod construct could provide a highest anti-rotation capacity, which is 68% and 210% greater than RF-F-10 screw-rod construct and USSII screw-rod respectively. The anti-rotational torque may be mainly affected by screw cap and groove design. Our result showed the anti-rotational torque are: Legacy system > RF-F-10 system > USSII system, suggesting that appropriate rod-screw constructs selection in surgery may be vital for anti-rotational torque improvement and preventing derotation correction loss.

Wear resistance of thick diamond like carbon coatings against polymeric materials used in single screw plasticizing technology

NASA Astrophysics Data System (ADS)

Zitzenbacher, G.; Liu, K.; Forsich, C.; Heim, D.

2015-05-01

Wear on the screw and barrel surface accompany polymer single screw plasticizing technology from the beginning. In general, wear on screws can be reduced by using nitrided steel surfaces, fused armour alloys on the screw flights and coatings. However, DLC-coatings (Diamond Like Carbon) comprise a number of interesting properties such as a high hardness, a low coefficient of friction and an excellent corrosion resistance due to their amorphous structure. The wear resistance of about 50 µm thick DLC-coatings against polyamide 6.6, polybutylene terephthalate and polypropylene is investigated in this paper. The tribology in the solids conveying zone of a single screw extruder until the beginning of melting is evaluated using a pin on disc tribometer and a so called screw tribometer. The polymeric pins are pressed against coated metal samples using the pin on disc tribometer and the tests are carried out at a defined normal force and sliding velocity. The screw tribometer is used to perform tribological experiments between polymer pellets and rotating coated metal shafts simulating the extruder screw. Long term experiments were performed to evaluate the wear resistance of the DLC-coating. A reduction of the coefficient of friction can be observed after a frictional distance of about 20 kilometers using glass fibre reinforced polymeric materials. This reduction is independent on the polymer and accompanied by a black layer on the wear surface of the polymeric pins. The DLC-coated metal samples show an up to 16 µm deep wear track after the 100 kilometer test period against the glass fiber filled materials only.

Accuracy of screw fixation using the O-arm® and StealthStation® navigation system for unstable pelvic ring fractures.

PubMed

Takeba, Jun; Umakoshi, Kensuke; Kikuchi, Satoshi; Matsumoto, Hironori; Annen, Suguru; Moriyama, Naoki; Nakabayashi, Yuki; Sato, Norio; Aibiki, Mayuki

2018-04-01

Screw fixation for unstable pelvic ring fractures is generally performed using the C-arm. However, some studies reported erroneous piercing with screws, nerve injuries, and vessel injuries. Recent studies have reported the efficacy of screw fixations using navigation systems. The purpose of this retrospective study was to investigate the accuracy of screw fixation using the O-arm ® imaging system and StealthStation ® navigation system for unstable pelvic ring fractures. The participants were 10 patients with unstable pelvic ring fractures, who underwent screw fixations using the O-arm StealthStation navigation system (nine cases with iliosacral screw and one case with lateral compression screw). We investigated operation duration, bleeding during operation, the presence of complications during operation, and the presence of cortical bone perforation by the screws based on postoperative CT scan images. We also measured the difference in screw tip positions between intraoperative navigation screen shot images and postoperative CT scan images. The average operation duration was 71 min, average bleeding was 12 ml, and there were no nerve or vessel injuries during the operation. There was no cortical bone perforation by the screws. The average difference between intraoperative navigation images and postoperative CT images was 2.5 ± 0.9 mm, for all 18 screws used in this study. Our results suggest that the O-arm StealthStation navigation system provides accurate screw fixation for unstable pelvic ring fractures.

Mechanical and histological analysis of bone-pedicle screw interface in vivo: titanium versus stainless steel.

PubMed

Sun, C; Huang, G; Christensen, F B; Dalstra, M; Overgaard, S; Bünger, C

1999-05-01

To investigate the differences in bone interface between titanium and stainless steel pedicle screws in the lumbar spine. Eighteen adult mini-pigs that underwent total laminectomy, posterolateral spinal fusion (L4-L5) were randomly selected to receive stainless steel (9) or titanium pedicle screw devices (9). In both groups, the devices were CCD (Sofamore Danek) type with the same size and shape. The postoperative observation time was 3 months. Screws from L4 were harvested along their long axis of pedicle for histomorphometric study. Bone-screw interface and bone volume from thread were examined using linear intercept techniques. Mechanical testing (torsional test and pull-out test) was performed on the screws from L5. The titanium screw group had a significantly higher maximum torque (P < 0.05) and angle related stiffness (P < 0.05) measured by torsional test. In the pull-out tests, no differences were found between the two groups in relation to the maximum load, stiffness and energy to failure. Direct bone contact with the screw in percentage was 29.4% for stainless steel and 43.8% for titanium (P < 0.05). No differences in the bone purchase between the vertebral body part and pedicle part were found. Pedicle screws made of titanium have a better bone-screw interface binding than screws made of stainless steel. Torsional tests are more informative for bone-screw interface study. Pull-out tests seem less valuable when comparing bone purchase of screws made from different materials.

Effects of Screw Configuration on the Preload Force of Implant-Abutment Screws.

PubMed

Zipprich, Holger; Rathe, Florian; Pinz, Sören; Schlotmann, Luca; Lauer, Hans-Christoph; Ratka, Christoph

The aim of this study was to investigate the effects of tightening torque, screw head angle, and thread number on the preload force of abutment screws. The test specimens consisted of three self-manufactured components (ie, a thread sleeve serving as an implant analog, an abutment analog, and an abutment screw). The abutment screws were fabricated with metric M1.6 external threads. The thread number varied between one and seven threads. The screw head angles were produced in eight varying angles (30 to 180 degrees). A sensor unit simultaneously measured the preload force of the screw and the torsion moment inside the screw shank. The tightening of the screw with the torque wrench was performed in five steps (15 to 35 Ncm). The torque wrench was calibrated before each step. Only the tightening torque and screw head angle affected the resulting preload force of the implant-abutment connection. The thread number had no effect. There was an approximately linear correlation between tightening torque and preload force. The tightening torque and screw head angle were the only study parameters that affected the resulting preload force of the abutment screw. The results obtained from this experiment are valid only for a single torque condition. Further investigations are needed that analyze other parameters that affect preload force. Once these parameters are known, it will add value for a strong, but detachable connection between the implant and abutment. Short implants and flat-to-flat connections especially will benefit significantly from this knowledge.

Control of epitaxial defects for optimal AlGaN/GaN HEMT performance and reliability

NASA Astrophysics Data System (ADS)

Green, D. S.; Gibb, S. R.; Hosse, B.; Vetury, R.; Grider, D. E.; Smart, J. A.

2004-12-01

High-quality GaN epitaxy continues to be challenged by the lack of matched substrates. Threading dislocations that result from heteroepitaxy are responsible for leakage currents, trapping effects, and may adversely affect device reliability. We have studied the impact of AlN nucleation conditions on the density and character of threading dislocations on SiC substrates. Variation of the nucleation temperature, V/III ratio, and thickness are seen to have a dramatic effect on the balance between edge, screw and mixed character dislocation densities. Electrical and structural properties have been assessed by AFM and XRD on a material level and through DC and RF performance at the device level. The ratio between dislocation characteristics has been established primarily through comparison of symmetric and asymmetric XRD rocking curve widths. The effect of each dislocation type on leakage current, RF power and reliability at 2 GHz, the targeted band for cell phone infrastructure applications, is discussed.

Undertapping of Lumbar Pedicle Screws Can Result in Tapping With a Pitch That Differs From That of the Screw, Which Decreases Screw Pullout Force.

PubMed

Bohl, Daniel D; Basques, Bryce A; Golinvaux, Nicholas S; Toy, Jason O; Matheis, Erika A; Bucklen, Brandon S; Grauer, Jonathan N

2015-06-15

Survey of spine surgeons and biomechanical comparison of screw pullout forces. To investigate what may be a suboptimal practice regularly occurring in spine surgery. In order for a tap to function in its intended manner, the pitch of the tap should be the same as the pitch of the screw. Undertapping has been shown to increase the pullout force of pedicle screws compared with line-to-line tapping. However, given the way current commercial lumbar pedicle screw systems are designed, undertapping may result in a tap being used that has a different pitch from that of the screw (incongruent pitch). A survey asked participants questions to estimate the proportion of cases each participant performed in the prior year using various hole preparation techniques. Participant responses were interpreted in the context of manufacturing specifications of specific instrumentation systems. Screw pullout forces were compared between undertapping with incongruent pitch and undertapping with congruent pitch using 0.16 g/cm polyurethane foam block and 6.5-mm screws. Of the 3679 cases in which participants reported tapping, participants reported line-to-line tapping in 209 cases (5%), undertapping with incongruent pitch in 1156 cases (32%), and undertapping with congruent pitch in 2314 cases (63%). The mean pullout force for undertapping with incongruent pitch was 56 N (8%) less than the mean pullout force for undertapping with congruent pitch. This is equivalent to 13 lb. This study estimates that for about 1 out of every 3 surgical cases with tapping of lumbar pedicle screws in the United States, hole preparation is being performed by undertapping with incongruent pitch. This study also shows that undertapping with incongruent pitch results in a decrease in pullout force by 8% compared with undertapping with congruent pitch. Steps should be taken to correct this suboptimal practice. 3.

Evaluation of Titanium-Coated Pedicle Screws: In Vivo Porcine Lumbar Spine Model.

PubMed

Kim, Do-Yeon; Kim, Jung-Ryul; Jang, Kyu Yun; Kim, Min Gu; Lee, Kwang-Bok

2016-07-01

Many studies have addressed the problem of loosening pedicle screws in spinal surgery, which is a serious concern. Titanium coating of medical implants (arthroplasty) is common, but few studies involving in vivo spine models have been reported. We evaluated the radiological, mechanical, and histological characteristics of titanium-coated pedicle screws compared with uncoated or hydroxyapatite-coated pedicle screws. Three different types of pedicle screws, i.e., uncoated, hydroxyapatite-coated, and titanium-coated, were implanted into the lumbar 3-4-5 levels of 9 mature miniature pigs. Radiological evaluation of loosening of pedicle screws was performed. Peak torsional extraction torque was tested in the 42 screws from 7 miniature pigs at 12 weeks postoperatively. The implant-bone interface of the remaining 12 pedicle screws from 2 miniature pigs in each group was assessed by micro-computed tomography and histologic studies. The incidence of loosening at 12 weeks postoperatively was not significantly different between the titanium-coated pedicle screw group and the other groups. The titanium-coated pedicle screw group exhibited the greatest mean extraction torsional peak torque at 12 weeks postoperatively (P < 0.05). Quantitative micro-computed tomography data were greatest in the titanium-coated pedicle screw group (P < 0.05). Histologic findings showed osteointegration with densely packed new bone formation at the screw coating-bone interface in the titanium-coated pedicle screw group. Fixation strength was greatest in the titanium-coated pedicle screw group. Osteointegration at the interface between the titanium-coated implant and bone produced prominent and firm bonding. The titanium-coated pedicle screw is a promising device for application in spinal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

The Influence of Various Factors on High School Football Helmet Face Mask Removal: A Retrospective, Cross-Sectional Analysis

PubMed Central

Swartz, Erik E; Decoster, Laura C; Norkus, Susan A; Cappaert, Thomas A

2007-01-01

Context: Most research on face mask removal has been performed on unused equipment. Objective: To identify and compare factors that influence the condition of helmet components and their relationship to face mask removal. Design: A cross-sectional, retrospective study. Setting: Five athletic equipment reconditioning/recertification facilities. Participants: 2584 helmets from 46 high school football teams representing 5 geographic regions. Intervention(s): Helmet characteristics (brand, model, hardware components) were recorded. Helmets were mounted and face mask removal was attempted using a cordless screwdriver. The 2004 season profiles and weather histories were obtained for each high school. Main Outcome Measure(s): Success and failure (including reason) for removal of 4 screws from the face mask were noted. Failure rates among regions, teams, reconditioning year, and screw color (type) were compared. Weather histories were compared. We conducted a discriminant analysis to determine if weather variables, region, helmet brand and model, reconditioning year, and screw color could predict successful face mask removal. Metallurgic analysis of screw samples was performed. Results: All screws were successfully removed from 2165 (84%) helmets. At least 1 screw could not be removed from 419 (16%) helmets. Significant differences were found for mean screw failure per helmet among the 5 regions, with the Midwest having the lowest failure rate (0.08 ± 0.38) and the Southern (0.33 ± 0.72), the highest. Differences were found in screw failure rates among the 46 teams (F1,45 = 9.4, P < .01). Helmets with the longest interval since last reconditioning (3 years) had the highest failure rate, 0.47 ± 0.93. Differences in success rates were found among 4 screw types (χ21,4 = 647, P < .01), with silver screws having the lowest percentage of failures (3.4%). A discriminant analysis (Λ = .932, χ214,n=2584 = 175.34, P < .001) revealed screw type to be the strongest predictor of successful removal. Conclusions: Helmets with stainless steel or nickel-plated carbon steel screws reconditioned in the previous year had the most favorable combination of factors for successful screw removal. T-nut spinning at the side screw locations was the most common reason and location for failure. PMID:17597938

Dynamic Flight Maneuvering Using Virtual Control Surfaces Generated by Trapped Vorticity

DTIC Science & Technology

2010-12-01

of a modified Dragon Eye UAV. These tests illustrated the possibility of controlled flight using open-loop flow control actuators. Future research...2 -1 0 1 2 z ( cm ) 0 1 2 3 4 5 1 2 3 4 5 Time (s)  (d eg ) Figure II-1 Step command tracking in plung: ideal reference model response...experimental results. The experimental results were obtained with the ball screws locked in position so that the wing model was only allowed to pitch

Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation.

PubMed

Sugawara, Taku; Higashiyama, Naoki; Kaneyama, Shuichi; Sumi, Masatoshi

2017-03-15

Prospective clinical trial of the screw insertion method for posterior C1-C2 fixation utilizing the patient-specific screw guide template technique. To evaluate the efficacy of this method for insertion of C1 lateral mass screws (LMS), C2 pedicle screws (PS), and C2 laminar screws (LS). Posterior C1LMS and C2PS fixation, also known as the Goel-Harms method, can achieve immediate rigid fixation and high fusion rate, but the screw insertion carries the risk of injury to neuronal and vascular structures. Dissection of venous plexus and C2 nerve root to confirm the insertion point of the C1LMS may also cause problems. We have developed an intraoperative screw guiding method using patient-specific laminar templates. Preoperative bone images of computed tomography (CT) were analyzed using three-dimensional (3D)/multiplanar imaging software to plan the trajectories of the screws. Plastic templates with screw guiding structures were created for each lamina using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all templates were specially designed to fit and lock on the lamina during the procedure. Surgery was performed using this patient-specific screw guide template system, and placement of the screws was postoperatively evaluated using CT. Twelve patients with C1-C2 instability were treated with a total of 48 screws (24 C1LMS, 20 C2PS, 4 C2LS). Intraoperatively, each template was found to exactly fit and lock on the lamina and screw insertion was completed successfully without dissection of the venous plexus and C2 nerve root. Postoperative CT showed no cortical violation by the screws, and mean deviation of the screws from the planned trajectories was 0.70 ± 0.42 mm. The multistep, patient-specific screw guide template system is useful for intraoperative screw navigation in posterior C1-C2 fixation. This simple and economical method can improve the accuracy of screw insertion, and reduce operation time and radiation exposure of posterior C1-C2 fixation surgery. 3.

[Case-control study on accuracy and safety of patient-specific drill-guide templates used in scoliosis cases].

PubMed

Zhang, Yu-peng; Shi, Ya-min; Wang, Hua-dong; Hou, Shu-xun

2015-10-01

To evaluate the accuracy and safety of pedicle screw insertion with the aid of novel patient-specific drill-guide templates in scoliosis cases. Ten patients with scoliosis were selected to participate in the research (the observation group) from December 2013 to December 2014. The data was obtained from CT scanning, and put into the computer to perform reconstruction of spine, simulation of pedicle screw insertion, and design of patient-specific drill-guide templates with software. The templates were made with rapid prototyping technique. After sterilization, the templates were used to aid the pedicle screw insertion intraoperatively. The blood loss, operation duration, change of creatinine level pre- and post-operation, and complications related to pedicle screw insertion were recorded. The location of pedicle screws were graded so as to evaluate the accuracy. A comparative study was then performed with the data of ten scoliosis cases operated with free-hand method during the same period (control group). There were 5 cases of idiopathic scoliosis and 5 cases of congenital scoliosis in the observation group, including 3 males and 7 females. Their average age was 11.9 years old (ranged, 4 to 18 years old), and the average Cobb angle of main curve was 54.9° (ranged, 42.1° to 78.4°). There were also 5 cases of idiopathic scoliosis and 5 cases of congenital scoliosis in the control group,including 2 males and 8 females. Their average age was 12.6 years old (ranged, 6 to 17 years old), and the average Cobb angle of main curve was 56.6° (ranged, 38.2° to 93.4°). A total of 167 pedicle screws were inserted intraoperatively, with 138 screws (82.6%) in grade I, 26 screws (15.0%) in grade II, 4 screws in grade III (2.4%), but no screws in grade IV according to the CT image. There were 29 (17.4%) screws perforated, and 163 (97.6%) screws could be accepted. In the control group, a total of 165 pedicle screws were inserted intraoperatively, with 98 screws (59.4%) in grade I, 39 screws (23.6%) in grade II, 21 screws in grade III (12.7%), and 7 screws in grade IV (4.2%). There were 67 (40.6%) screws perforated, and 137 (83.0%) screws could be accepted. The grade distribution of screw position, ratio of perforated and accepted screws were significantly different between the two groups respectively (Z=-5.013, P=0.000; χ2=9.347, P=0.002; χ2=20.242, P=0.000). The correction rate of Cobb angle were (74.1±10.0)% vs (69.7±17.6)%; blood loss were (455±447) ml vs (415±389) ml; operation duration were (163.5±53.7) min vs (164.0±48.7) min; and the changes of creatinine level pre- and post-operatively were (-5.3±3.2) μmol/L vs (-3.4±3.1) μmol/L; all above data had no significant differences respectively (t=0.696, P=0.496; t=0.214, P=0.833; t=0.022, P=0.983; t=1.375, P=0.192). There were no complications related to pedicle screw insertion in each group. The novel patient-specific drill guide template can be used to assist the insertion of pedicle screws in scoliosis cases with much higher accuracy than that of freehand method and fair safety.

The effect of screw taper on interference fit during load to failure at the soft tissue/bone interface.

PubMed

Mann, Charles J; Costi, John J; Stanley, Richard M; Dobson, Peter J

2005-10-01

The effect of screw geometry on the pullout strength of an anterior cruciate ligament reconstruction is well documented. The effect of a truly tapered screw has not been previously investigated. Thirty bovine knees in right and left knee pairs were collected. Superficial digital flexors from the hind legs of sheep were harvested to form a quadruple tendon graft. For each knee pair, one tendon graft was fixed using a tapered screw (n=15) and the other with a non-tapered screw (n=15). Interference screws were manufactured from stainless steel, and apart from the tapered or non-tapered profile were identical. The screws were inserted into a tibial tunnel already containing the tendon graft. The interference fit was tested by extensile load to failure tests. The insertion torque of the screws and first sign of load to failure (by pullout) of the interference fit were recorded. Results were analysed using paired t-tests. The results indicated that tapered screws have significantly higher resistance to interference failure (p=0.007) and insertion torque (p<0.001) than non-tapered screws. The improved biomechanical performance of tapered screws demonstrated in this study may translate into superior clinical results, particularly at the tibial attachment of hamstring anterior cruciate ligament reconstruction, and also of hamstring fixation to the medial femoral condyle for patella instability.

Pedicle screw placement using image guided techniques.

PubMed

Merloz, P; Tonetti, J; Pittet, L; Coulomb, M; Lavalleé, S; Sautot, P

1998-09-01

Clinical evaluation of a computer assisted spine surgical system is presented. Eighty pedicle screws were inserted using computer assisted technology in thoracic and lumbar vertebrae for treatment of different types of disorders including fractures, spondylolisthesis, and scoliosis. Fifty-two patients with severe fractures, spondylolisthesis, or pseudoarthrosis of T10 to L5 were treated using a computer assisted technique on 1/2 the patients and performing the screw insertion manually for the other 1/2. At the same time, 28 pedicle screws were inserted in T12 to L4 vertebrae for scoliosis with the help of the computer assisted technique. Surgery was followed in all cases (66 vertebrae; 132 pedicle screws) by postoperative radiographs and computed tomographic examination, on which measurements of screw position relative to pedicle position could be done. For fractures, spondylolisthesis, or pseudarthrosis, comparison between the two groups showed that four screws in 52 (8%) vertebrae had incorrect placement with computer assisted technique whereas 22 screws in 52 (42%) vertebrae had incorrect placement with manual insertion. In patients with scoliosis, four screws in 28 (14%) vertebrae had incorrect placement. In all of the patients (132 pedicle screws) there were no neurologic complications. These results show that a computer assisted technique is much more accurate and safe than manual insertion.

Biomechanical competence of six different bone screws for reconstructive surgery in three different transplants: Fibular, iliac crest, scapular and artificial bone.

PubMed

Pietsch, Arnold P; Raith, Stefan; Ode, Jan-Eric; Teichmann, Jan; Lethaus, Bernd; Möhlhenrich, Stephan C; Hölzle, Frank; Duda, Georg N; Steiner, Timm

2016-06-01

The goal of this study was to determine a combination of screw and transplantation type that offers optimal primary stability for reconstructive surgery. Fibular, iliac crest, and scapular transplants were tested along with artificial bone substrate. Six different kinds of bone screws (Medartis(©)) were compared, each type utilized with one of six specimens from human transplants (n = 6). Controlled screw-in-tests were performed and the required torque was protocolled. Subsequently, pull-out-tests were executed to determine the retention forces. The artificial bone substitute material showed significantly higher retention forces than real bone samples. The self-drilling screws achieved the significantly highest retention values in the synthetic bone substitute material. Cancellous screws achieved the highest retention in the fibular transplants, while self-drilling and cancellous screws demonstrated better retention than cortical screws in the iliac crest. In the scapular graft, no significant differences were found between the screw types. In comparison to the human transplant types, the cortical screws showed the significantly highest values in the fibula and the lowest values in the iliac crest. The best retention was found in the combination of cancellous screws with fibular graft (514.8 N + -252.3 N). For the flat bones (i.e., scapular and illiac crest) we recommend the cancellous screws. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparison of success rates of orthodontic mini-screws by the insertion method.

PubMed

Kim, Jung Suk; Choi, Seong Hwan; Cha, Sang Kwon; Kim, Jang Han; Lee, Hwa Jin; Yeom, Sang Seon; Hwang, Chung Ju

2012-10-01

The aim of this study was to compare the success rates of the manual and motor-driven mini-screw insertion methods according to age, gender, length of mini-screws, and insertion sites. We retrospectively reviewed 429 orthodontic mini-screw placements in 286 patients (102 in men and 327 in women) between 2005 and 2010 at private practice. Age, gender, mini-screw length, and insertion site were cross-tabulated against the insertion methods. The Cochran-Mantel-Haenszel test was performed to compare the success rates of the 2 insertion methods. The motor-driven method was used for 228 mini-screws and the manual method for the remaining 201 mini-screws. The success rates were similar in both men and women irrespective of the insertion method used. With respect to mini-screw length, no difference in success rates was found between motor and hand drivers for the 6-mm-long mini-screws (68.1% and 69.5% with the engine driver and hand driver, respectively). However, the 8-mm-long mini-screws exhibited significantly higher success rates (90.4%, p < 0.01) than did the 6-mm-long mini-screws when placed with the engine driver. The overall success rate was also significantly higher in the maxilla (p < 0.05) when the engine driver was used. Success rates were similar among all age groups regardless of the insertion method used. Taken together, the motor-driven insertion method can be helpful to get a higher success rate of orthodontic mini-screw placement.

Utilization of Screw Piles in High Seismicity Areas of Cold and Warm Permafrost

DOT National Transportation Integrated Search

2010-07-01

This work was performed in support of the AUTC project Utilization of Screw Piles in : High Seismicity Areas of Cold and Warm Permafrost under the direction of PI Dr. Kenan : Hazirbaba. Surface wave testing was performed at 30 sites in the City...

Mini-screws success rates sufficient for orthodontic treatment.

PubMed

Stanford, Nicky

2011-01-01

Medline. Clinical trials of orthodontic mini-screws with a minimum of 30 cases providing data on the patient, mini-screw, surgery and loading available for correlation with the mini-screws' success rates in English or German were included. Data were extracted that correlated with the miniscrews' success rate: patient sex and age, screw length and diameter, method and location of placement, time and amount of loading. The statistical analyses were performed using SPSS software (version 13 for Mac OS X, SPSS, Chicago, Ill). Fourteen clinical trials (452 patients and 1519 screws) were included, with overall success rates ranging from 59.4% to 100%. The mean success rate was 83.6% ± 10.2%. Screw diameters of 1 to 1.1 mm yielded significantly lower success rates than those of 1.5 to 2.3 mm. One study reported significantly lower success rates for 6 mm vs 8 mm long mini-screws (72% vs 90%). Screw placement with or without a surgical flap showed contradictory results between studies. Three studies showed significantly higher success rates for maxillary than for mandibular screws. Loading and healing periods were not significant in the mini-screws' success rates. There was no influence of patient sex and one study found significantly greater success in patients over 30 years of age. All 14 articles described success rates sufficient for orthodontic treatment. Placement protocols varied markedly. Screws under 8 mm in length and 1.2 mm in diameter should be avoided. Immediate or early loading up to 200 cN was adequate and showed no significant influence on screw stability.

Theoretical and experimental analysis of a multiphase screw pump, handling gas-liquid mixtures with very high gas volume fractions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raebiger, K.; Faculty of Advanced Technology, University of Glamorgan, Pontypridd, Wales; Maksoud, T.M.A.

In the investigation of the pumping behaviour of multiphase screw pumps, handling gas-liquid mixtures with very high gas volume fractions, theoretical and experimental analyses were performed. A new theoretical screw pump model was developed, which calculates the time-dependent conditions inside the several chambers of a screw pump as well as the exchange of mass and energy between these chambers. By means of the performed experimental analysis, the screw pump model was verified, especially at very high gas volume fractions from 90% to 99%. The experiments, which were conducted with the reference fluids water and air, can be divided mainly intomore » the determination of the steady state pumping behaviour on the one hand and into the analysis of selected transient operating conditions on the other hand, whereas the visualisation of the leakage flows through the circumferential gaps was rounded off the experimental analysis. (author)« less

Experimental investigation of the fracture torque of orthodontic anchorage screws.

PubMed

Reimann, Susanne; Ayubi, Mustafa; McDonald, Fraser; Bourauel, Christoph

2016-07-01

In contrast to dental implants that remain in the bone, orthodontic anchorage screws serve as temporary anchorage for orthodontic tooth movement and are removed after completion of treatment. The aim of the present study was to evaluate the stability of various commercially available orthodontic anchorage screws against torsion. The torsional deflection of ten different orthodontic anchorage screws from different manufacturers [Ortho Easy Pin (Forestadent), Benefit, quattro (both PSM Medical Solutions), Vector TAS (Ormco), AbsoAnchor(®) (DENTOS Inc.), OrthoLox, Dual-Top JA (both Promedia Medizintechnik), TAD (3M Unitek), INFINITAS (ODS) and tomas(®) (Dentaurum)] was tested in vitro in relation to the rotation angle using a self-developed set-up. The screws were positioned in a resin model with bone-like material properties. Shear tests were performed using the manufacturers' own screwdrivers. Ten screws each were turned manually until a sudden drop in the measured torque occurred. At this point, the screw head was twisted off. Fracture torque and the torque at which the screws deformed plastically were evaluated. Mean values and standard deviations were calculated. According to the German industrial standard, the torque of orthodontic anchorage screws should reach at least 20 Ncm. The majority of the screws reached this nominal torque; however, a few screws fractured before reaching this value. Five screw types displayed plastic deformation below the threshold, at approximately 16 Ncm. The results suggest that orthodontic anchorage screws generally meet the requirements of the standard and ensure safe clinical use. However, according to the present data, it may be assumed that a portion of the screws will be plastically deformed upon removal.

The applicability of PEEK-based abutment screws.

PubMed

Schwitalla, Andreas Dominik; Abou-Emara, Mohamed; Zimmermann, Tycho; Spintig, Tobias; Beuer, Florian; Lackmann, Justus; Müller, Wolf-Dieter

2016-10-01

The high-performance polymer PEEK (poly-ether-ether-ketone) is more and more being used in the field of dentistry, mainly for removable and fixed prostheses. In cases of screw-retained implant-supported reconstructions of PEEK, an abutment screw made of PEEK might be advantageous over a conventional metal screw due to its similar elasticity. Also in case of abutment screw fracture, a screw of PEEK could be removed more easily. M1.6-abutment screws of four different PEEK compounds were subjected to tensile tests to set their maximum tensile strengths in relation to an equivalent stress of 186MPa, which is aused by a tightening torque of 15Ncm. Two screw types were manufactured via injection molding and contained 15% short carbon fibers (sCF-15) and 40% (sCF-40), respectively. Two screw types were manufactured via milling and contained 20% TiO2 powder (TiO2-20) and >50% parallel orientated, continuous carbon fibers (cCF-50). A conventional abutments screw of Ti6Al4V (Ti; CAMLOG(®) abutment screw, CAMLOG, Wimsheim, Germany) served as control. The maximum tensile strength was 76.08±5.50MPa for TiO2-20, 152.67±15.83MPa for sCF-15, 157.29±20.11MPa for sCF-40 and 191.69±36.33MPa for cCF-50. The maximum tensile strength of the Ti-screws amounted 1196.29±21.4MPa. The results of the TiO2-20 and the Ti screws were significantly different from the results of the other samples, respectively. For the manufacturing of PEEK abutment screws, PEEK reinforced by >50% continuous carbon fibers would be the material of choice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Breakdown Degradation Associated with Elementary Screw Dislocations in 4H-SiC P(+)N Junction Rectifiers

NASA Technical Reports Server (NTRS)

Neudeck, P. G.; Huang, W.; Dudley, M.

1998-01-01

It is well-known that SiC wafer quality deficiencies are delaying the realization of outstandingly superior 4H-SiC power electronics. While efforts to date have centered on eradicating micropipes (i.e., hollow core super-screw dislocations with Burgers vector greater than 2c), 4H-SiC wafers and epilayers also contain elementary screw dislocations (i.e., Burgers vector = lc with no hollow core) in densities on the order of thousands per sq cm, nearly 100-fold micropipe densities. This paper describes an initial study into the impact of elementary screw dislocations on the reverse-bias current-voltage (I-V) characteristics of 4H-SiC p(+)n diodes. First, Synchrotron White Beam X-ray Topography (SWBXT) was employed to map the exact locations of elementary screw dislocations within small-area 4H-SiC p(+)n mesa diodes. Then the high-field reverse leakage and breakdown properties of these diodes were subsequently characterized on a probing station outfitted with a dark box and video camera. Most devices without screw dislocations exhibited excellent characteristics, with no detectable leakage current prior to breakdown, a sharp breakdown I-V knee, and no visible concentration of breakdown current. In contrast devices that contained at least one elementary screw dislocation exhibited a 5% to 35% reduction in breakdown voltage, a softer breakdown I-V knee, and visible microplasmas in which highly localized breakdown current was concentrated. The locations of observed breakdown microplasmas corresponded exactly to the locations of elementary screw dislocations identified by SWBXT mapping. While not as detrimental to SiC device performance as micropipes, the undesirable breakdown characteristics of elementary screw dislocations could nevertheless adversely affect the performance and reliability of 4H-SiC power devices.

Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength.

PubMed

Weiser, Lukas; Huber, Gerd; Sellenschloh, Kay; Viezens, Lennart; Püschel, Klaus; Morlock, Michael M; Lehmann, Wolfgang

2017-11-01

Loosening of pedicle screws is one major complication of posterior spinal stabilisation, especially in the patients with osteoporosis. Augmentation of pedicle screws with cement or lengthening of the instrumentation is widely used to improve implant stability in these patients. However, it is still unclear from which value of bone mineral density (BMD) the stability of pedicle screws is insufficient and an additional stabilisation should be performed. The aim of this study was to investigate the correlation of bone mineral density and pedicle screw fatigue strength as well as to define a threshold value for BMD below which an additional stabilisation is recommended. Twenty-one human T12 vertebral bodies were collected from donors between 19 and 96 years of age and the BMD was measured using quantitative computed tomography. Each vertebral body was instrumented with one pedicle screw and mounted in a servo-hydraulic testing machine. Fatigue testing was performed by implementing a cranio-caudal sinusoidal, cyclic (0.5 Hz) load with stepwise increasing peak force. A significant correlation between BMD and cycles to failure (r = 0.862, r 2  = 0.743, p < 0.001) as well as for the linearly related fatigue load was found. Specimens with BMD below 80 mg/cm 3 only reached 45% of the cycles to failure and only 60% of the fatigue load compared to the specimens with adequate bone quality (BMD > 120 mg/cm 3 ). There is a close correlation between BMD and pedicle screw stability. If the BMD of the thoracolumbar spine is less than 80 mg/cm 3 , stability of pedicle screws might be insufficient and an additional stabilisation should be considered.

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique.

PubMed

Paredes, Igor; Panero, Irene; Cepeda, Santiago; Castaño-Leon, Ana M; Jimenez-Roldan, Luis; Perez-Nuñez, Ángel; Alén, Jose A; Lagares, Alfonso

2018-06-14

This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). Forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagital angle postoperatively and at 12-month follow up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. Mean age was 42 years old. Mean TLICS score was 6,29 and 5,96 for open and MIS groups respectively. Twenty five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7,14 per patient). Twenty-four and 13 screws were considered ̈out ̈ in the open and MIS groups respectively (Odds ratio 1,98. 0,97-4,03 p=0,056). The Cobb sagittal angle went from 13,3o to 4,5o and from 14,9o to 8,2o in the Open and MIS groups respectively (both p<0,0001). Loss of correction at 12-month follow up was 3,2o and 4,2o for the open and MIS groups respectively. No neurological worsening was observed. For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.

The Development of using the digital projection method to measure the contact angle of ball screw

NASA Astrophysics Data System (ADS)

Chen, Chun-Jen; Jywe, Wenyuh; Liu, Yu-Chun; Jwo, Hsin-Hong

The ball screw frequently used to drive or translate the parts on the precision machine, such as machine tool and motorized stage. Therefore they were most frequently used on the precision machine, semiconductor equipment, medical instrument and aero industry. The main parts of ball screw are screw, ball and nut. The contact angle between the screw, ball and nut will affect the performance (include loading and noise) and lifecycle of a ball screw. If the actual contact angle and the designed contact angle are not the same, the friction between the ball, screw and nut will increase and it will result in the thermal increase and lifecycle decrease. This paper combines the traditional profile projector and commercial digital camera to build an imaging based and noncontact measurements system. It can implement the contact angle measurement quickly and accurately. Three different pitch angles of ball screws were completed tests in this paper. The angle resolution of this measurement system is about 0.001 degree and its accuracy is about 0.05 degree.

An approximate model for cancellous bone screw fixation.

PubMed

Brown, C J; Sinclair, R A; Day, A; Hess, B; Procter, P

2013-04-01

This paper presents a finite element (FE) model to identify parameters that affect the performance of an improved cancellous bone screw fixation technique, and hence potentially improve fracture treatment. In cancellous bone of low apparent density, it can be difficult to achieve adequate screw fixation and hence provide stable fracture fixation that enables bone healing. Data from predictive FE models indicate that cements can have a significant potential to improve screw holding power in cancellous bone. These FE models are used to demonstrate the key parameters that determine pull-out strength in a variety of screw, bone and cement set-ups, and to compare the effectiveness of different configurations. The paper concludes that significant advantages, up to an order of magnitude, in screw pull-out strength in cancellous bone might be gained by the appropriate use of a currently approved calcium phosphate cement.

The influence of the insertion technique on the pullout force of pedicle screws: an experimental study.

PubMed

Chatzistergos, Panagiotis E; Sapkas, George; Kourkoulis, Stavros K

2010-04-20

The pullout strength of a typical pedicle screw was evaluated experimentally for different screw insertion techniques. OBJECTIVE.: To conclude whether the self-tapping insertion technique is indeed the optimum one for self-tapping screws, with respect to the pullout strength. It is reported in the literature that the size of the pilot-hole significantly influences the pullout strength of a self-tapping screw. In addition it is accepted that an optimum value of the diameter of the pilot-hole exists. For non self-tapping screw insertion it is reported that undertapping of the pilot-hole can increase its pullout strength. Finally it is known that in some cases orthopedic surgeons open the threaded holes, using another screw instead of a tap. A typical commercial self-tapping pedicle screw was inserted into blocks of Solid Rigid Polyurethane Foam (simulating osteoporotic cancellous bone), following different insertion techniques. The pullout force was measured according to the ASTM-F543-02 standard. The screw was inserted into previously prepared holes of different sizes, either threaded or cylindrical, to conclude whether an optimum size of the pilot-hole exists and whether tapping can increase the pullout strength. The case where the tapping is performed using another screw was also studied. For screw insertion with tapping, decreasing the outer radius of the threaded hole from 1.00 to 0.87 of the screw's outer radius increased the pullout force 9%. For insertion without tapping, decreasing the pilot-hole's diameter from 0.87 to 0.47 of the screw's outer diameter increased its pullout force 75%. Finally, tapping using another screw instead of a tap, gave results similar to those of conventional tapping. Undertapping of a pilot-hole either using a tap or another screw can increase the pullout strength of self-tapping pedicle screws.

The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients.

PubMed

Zhang, Xin-Liang; Huang, Da-Geng; Wang, Xiao-Dong; Zhu, Jin-Wen; Li, Yi-Bing; He, Bao-Rong; Hao, Ding-Jun

2017-04-01

Ponticulus posticus is a common anatomic variation that can be mistaken for a broad posterior arch during C1 pedicle screw placement. When the atlas lateral mass screws are placed via the posterior arch, injury to the vertebral artery may result. To our knowledge, there are few clinical studies that have analyzed the feasibility of C1 pedicle screw fixation in patients with ponticulus posticus, in clinical practice. To evaluate the feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus. Between January 2008 and January 2012, 11 consecutive patients with atlantoaxial instability, and with a ponticulus posticus at C1, underwent posterior fusion surgery in our institution. According to preoperative computed tomography (CT) reconstruction, a complete ponticulus posticus was found unilaterally in nine patients and bilaterally in two. Postoperative CT reconstructive imaging was performed to assess whether C1 pedicle screw placement was successful. Patients were followed up at regular intervals and evaluated for symptoms of ponticulus posticus syndrome. Thirteen C1 pedicles (atlas vertebral artery groove), each with a complete ponticulus posticus, were successfully inserted with thirteen 3.5- or 4.0-mm diameter pedicle screws, without resection of the bony anomaly. No intraoperative complications (venous plexus, vertebral artery, or spinal cord injury) occurred. The mean follow-up period was 21 (range 14-30) months. Postoperative CT reconstructive images showed that all 13 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. In the follow-up period, none of the patients demonstrated clinical symptoms of ponticulus posticus syndrome or developed bone fusion. Three-dimensional CT imaging should be considered prior to C1 pedicle screw fixation in patients with ponticulus posticus, to avoid mistaking the ponticulus posticus for a widened dorsal arch of the atlas. If there is no ponticulus posticus syndrome preoperatively, C1 pedicle screw fixation can be successfully performed without removing the bony anomaly.

Reliability and Usefulness of Intraoperative 3-Dimensional Imaging by Mobile C-Arm With Flat-Panel Detector.

PubMed

Fujimori, Takahito; Iwasaki, Motoki; Nagamoto, Yukitaka; Kashii, Masafumi; Takao, Masaki; Sugiura, Tsuyoshi; Yoshikawa, Hideki

2017-02-01

Reliability and agreement study. To assess the reliability of intraoperative 3-dimensional imaging with a mobile C-arm (3D C-arm) equipped with a flat-panel detector. Pedicle screws are widely used in spinal surgery. Postoperative computed tomography (CT) is the most reliable method to detect screw misplacement. Recent advances in imaging devices have enabled surgeons to acquire 3D images of the spine during surgery. However, the reliability of these imaging devices is not known. A total of 203 screws were used in 22 consecutive patients who underwent surgery for scoliosis. Screw position was read twice with a 3D C-arm and twice with CT in a blinded manner by 2 independent observers. Screw positions were classified into 4 categories at every 2 mm and then into 2 simpler categories of acceptable or unacceptable. The degree of agreement with respect to screw positions between the double readings was evaluated by κ value. With unanimous agreement between 2 observers regarding postoperative CT readings considered the gold standard, the sensitivity of the 3D C-arm for determining screw misplacement was calculated. A total 804 readings were performed. For the 4-category classification, the mean κ value for the 2 interobserver readings was 0.52 for the 3D C-arm and 0.46 for CT. For the 2-category classification, the mean κ value for the 2 interobserver readings was 0.80 for the 3D C-arm and 0.66 for CT. The sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative imaging with the 3D C-arm were 70%, 95%, 44%, and 98%, respectively. With respect to screws with perforation ≥4 mm, the sensitivity was 83%. No revision surgery was performed. Intraoperative imaging with a 3D C-arm was reliable for detecting screw misplacement and helpful in decreasing the rate of revision surgery for screw misplacement.

Effect of screw torque level on cortical bone pullout strength.

PubMed

Cleek, Tammy M; Reynolds, Karen J; Hearn, Trevor C

2007-02-01

The objectives of this study were 2-fold: (1) to perform detailed analysis of cortical screw tightening stiffness during automated insertion, and (2) to determine the effect of 3 torque levels on the holding strength of the bone surrounding the screw threads as assessed by screw pullout. Ten pairs of ovine tibiae were used with 3 test sites spaced 20 mm apart centered along the shaft. One side of each pair was used for measuring ultimate failure torque (Tmax). These Tmax and bone-density values were used to predict Tmax at contralateral tibia sites. Screws were inserted and tightened to 50%, 70%, and 90% of predicted Tmax at the contralateral sites to encompass the average clinical level of torque (86% Tmax). Pullout tests were performed and maximum force values were normalized by cortical thickness. Torque to failure tests indicated tightening to 86% Tmax occurs after yield and leads to an average 51% loss in stiffness. Normalized pullout strength for screws tightened to 50% Tmax, 70% Tmax, and 90% Tmax were 2525 +/- 244, 2707 +/- 280, and 2344 +/- 346 N, respectively, with a significant difference between 70% Tmax and 90% Tmax groups (P < 0.05). Within the limitations of our study involving the testing of 1 type of screw purchase in ovine tibiae, results demonstrate that clinical levels of lag screw tightening (86% Tmax) are past the yield point of bone. Tightening to these high torque levels can cause damage leading to compromised holding strength. Further research is still required to establish the appropriate level of torque required for achieving optimal fracture fixation and healing.

Spring Outmigration of Wild and Hatchery Chinook Salmon and Steelhead Trout Smolts from the Imnaha River, Oregon; 1996 Annual Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blenden, Michael L.; Rocklage, Stephen J.; Kucera, Paul A.

1997-04-01

For the third consecutive year, the Nez Perce Tribe, in conjunction with the Fish Passage Center, participated in the smolt monitoring program in the Imnaha River. A rotary screw trap was used to collect emigrating wild and hatchery chinook salmon (Oncorhynchus tshawytscha) and steelhead trout (Oncorhynchus mykiss) smolts from February 23 to June 24, 1996. A total of 1,797 wild chinook salmon, 11,896 hatchery chinook salmon, 3,786 wild steelhead trout, and 31,094 hatchery steelhead trout smolts were captured during outmigration studies on the Imnaha River in 1996. Mortality associated with trapping, handling and tagging was low, being 1.4% for wildmore » chinook, 0.18% for hatchery chinook, 0.21% for wild steelhead and 0.28% for hatchery steelhead trout smolts.« less

Biomechanical Comparisons of Pull Out Strengths After Pedicle Screw Augmentation with Hydroxyapatite, Calcium Phosphate, or Polymethylmethacrylate in the Cadaveric Spine.

PubMed

Yi, Seong; Rim, Dae-Cheol; Park, Seoung Woo; Murovic, Judith A; Lim, Jesse; Park, Jon

2015-06-01

In vertebrae with low bone mineral densities pull out strength is often poor, thus various substances have been used to fill screw holes before screw placement for corrective spine surgery. We performed biomechanical cadaveric studies to compare nonaugmented pedicle screws versus hydroxyapatite, calcium phosphate, or polymethylmethacrylate augmented pedicle screws for screw tightening torques and pull out strengths in spine procedures requiring bone screw insertion. Seven human cadaveric T10-L1 spines with 28 vertebral bodies were examined by x-ray to exclude bony abnormalities. Dual-energy x-ray absorptiometry scans evaluated bone mineral densities. Twenty of 28 vertebrae underwent ipsilateral fluoroscopic placement of 6-mm holes augmented with hydroxyapatite, calcium phosphate, or polymethylmethacrylate, followed by transpedicular screw placements. Controls were pedicle screw placements in the contralateral hemivertebrae without augmentation. All groups were evaluated for axial pull out strength using a biomechanical loading frame. Mean pedicle screw axial pull out strength compared with controls increased by 12.5% in hydroxyapatite augmented hemivertebrae (P = 0.600) and by 14.9% in calcium phosphate augmented hemivertebrae (P = 0.234), but the increase was not significant for either method. Pull out strength of polymethylmethacrylate versus hydroxyapatite augmented pedicle screws was 60.8% higher (P = 0.028). Hydroxyapatite and calcium phosphate augmentation in osteoporotic vertebrae showed a trend toward increased pedicle screw pull out strength versus controls. Pedicle screw pull out force of polymethylmethacrylate in the insertion stage was higher than that of hydroxyapatite. However, hydroxyapatite is likely a better clinical alternative to polymethylmethacrylate, as hydroxyapatite augmentation, unlike polymethylmethacrylate augmentation, stimulates bone growth and can be revised. Copyright © 2015 Elsevier Inc. All rights reserved.

Screw fixation versus arthroplasty versus plate fixation for 3-part radial head fractures.

PubMed

Wu, P H; Shen, L; Chee, Y H

2016-04-01

To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.

Screw Versus Plate Fixation for Chevron Osteotomy: A Retrospective Study.

PubMed

Andrews, Boyd J; Fallat, Lawrence M; Kish, John P

2016-01-01

The chevron osteotomy is a popular procedure used for the correction of moderate hallux abducto valgus deformity. Fixation is typically accomplished with Kirschner wires or bone screws; however, in cystic or osteoporotic bone, these could be inadequate, resulting in displacement of the capital fragment. We propose using a locking plate and interfragmental screw for fixation of the chevron osteotomy that could reduce the healing time and decrease the incidence of displacement. We performed a retrospective cohort study for chevron osteotomies on 75 feet (73 patients). The control groups underwent fixation with 1 screw in 30 feet (40%) and 2 screws in 30 feet (40%). A total of 15 feet (20%) were included in the locking plate and interfragmental screw group. The patients were followed up until bone healing was achieved at a median of 7 (range 6 to 14) weeks. Our hypothesis was that those treated with the locking plate and interfragmental screw would have a faster healing time and fewer incidents of capital fragment displacement compared with the 1- or 2-screw groups. The corresponding mean intervals to healing for the 1-screw group was 7.71 ± 1.28 (range 6 to 10) weeks, for the 2-screw group was 7.27 ± 1.57 (range 6 to 14) weeks, and for the locking plate and interfragmental screw group was 7.01 ± 1.00 (range 6 to 9) weeks. One case of capital fragment displacement occurred in the single screw group and one in the 2-screw group. No displacement occurred in the locking plate and interfragmental screw group. Neither finding was statistically significant. However, we believe the locking plate and interfragmental screw could be a viable option in patients with osteoporotic and cystic bone changes for correction of hallux abducto valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population.

PubMed

Macke, Jeremy J; Woo, Raymund; Varich, Laura

2016-06-01

This is a retrospective review of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients under 18 years of age who underwent robot-assisted corrective surgery. Our primary objective was to characterize the accuracy of pedicle screw placement with evaluation by computed tomography (CT) after robot-assisted surgery in AIS patients. Screw malposition is the most frequent complication of pedicle screw placement and is more frequent in AIS. Given the potential for serious complications, the need for improved accuracy of screw placement has spurred multiple innovations including robot-assisted guidance devices. No studies to date have evaluated this robot-assisted technique using CT exclusively within the AIS population. Fifty patients were included in the study. All operative procedures were performed at a single institution by a single pediatric orthopedic surgeon. We evaluated the grade of screw breach, the direction of screw breach, and the positioning of the patient for preoperative scan (supine versus prone). Of 662 screws evaluated, 48 screws (7.2 %) demonstrated a breach of greater than 2 mm. With preoperative prone position CT scanning, only 2.4 % of screws were found to have this degree of breach. Medial malposition was found in 3 % of screws, a rate which decreased to 0 % with preoperative prone position scanning. Based on our results, we conclude that the proper use of image-guided robot-assisted surgery can improve the accuracy and safety of thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis. This is the first study to evaluate the accuracy of pedicle screw placement using CT assessment in robot-assisted surgical correction of patients with AIS. In our study, the robot-assisted screw misplacement rate was lower than similarly constructed studies evaluating conventional (non-robot-assisted) procedures. If patients are preoperatively scanned in the prone position, the misplacement rate is further decreased.

Radiographic predictors of symptomatic screw removal after retrograde femoral nail insertion.

PubMed

Hamaker, Max; O'Hara, Nathan N; Eglseder, W Andrew; Sciadini, Marcus F; Nascone, Jason W; O'Toole, Robert V

2017-03-01

Removal of symptomatic implants is a common procedure performed by orthopaedic trauma surgeons. No guidance is available regarding which factors contribute to the likelihood of an implant becoming symptomatic. Our objective was to determine whether radiographic parameters associated with distal interlocks in retrograde femoral nails are associated with the rate of symptomatic screw removal. We conducted a retrospective review at a Level I trauma center. Study patients (n=442) had femoral fractures treated with retrograde intramedullary nails from 2007 to 2014 and at least 1year of follow-up. The main outcome measurement was symptomatic distal screw removal as predicted by radiographic parameters. Symptomatic screw removal occurred in 12% of the patients. Increased distance between the most distal screw and the articular surface of the femur significantly reduced likelihood of symptomatic screw removal. A cutoff of 40mm from the articular block was predictive of removal (≥40mm, 0% removal; <40mm, 18% removal, p<0.0001). In patients with distal screws placed within 40mm of the articular surface of the femur, a ratio of screw length to distance between medial and lateral femoral cortices that was ≥1 was a strong predictor of symptomatic screw removal (area under Receiver Operating Characteristic curve, 0.75; p<0.0001). More distal screws and screws that radiographically extend to or beyond the medial cortex are more likely to cause pain and require removal in femoral fractures treated with retrograde intramedullary nails. We identified a specific distance from the joint (<40mm) and a ratio of screw length to bone width (≥1) that significantly increased the likelihood of symptomatic screw removal. Clinicians can use these data to inform patients of the likely risk of implant removal and perhaps to better guide placement and length of screws when the clinical scenario allows some flexibility in location and length of screws. Copyright © 2017 Elsevier Ltd. All rights reserved.

Osteosynthesis of partial rib osteotomy in a miniature pig model using human standard-sized magnesium plate/screw systems: Effect of cyclic deformation on implant integrity and bone healing.

PubMed

Schaller, Benoit; Saulacic, Nikola; Beck, Stefan; Imwinkelried, Thomas; Liu, Edwin Wei Yang; Nakahara, Ken; Hofstetter, Willy; Iizuka, Tateyuki

2017-06-01

Magnesium alloys are candidates for resorbable material in bone fixation. However, the degradation and performance of osteosynthesis plate/screw systems in vivo, under cyclic deformation, is unknown. We evaluated the outcomes of human standard-sized magnesium plate/screw systems with or without plasma-electrolytic surface modifications in a miniature pig rib model. Of a total of 14 minipigs, six were implanted with coated magnesium WE43 six-hole plates/screws, six received magnesium uncoated plates/screws, and two received titanium osteosynthesis systems. The performance of the plate/screw fixation system on partially osteotomized 7th ribs was compared with that on intact 9th ribs. Radiological examinations were performed in vivo at 1, 4 and 8 weeks and after euthanasia at 12 and 24 weeks. After euthanasia the bone blocks were analyzed by computed tomography (CT), microfocus computed tomography (micro-CT), histology and histomorphometry. Follow-up post-surgery showed no trouble with wound healing. In vivo radiological examinations showed higher amounts of gas formation above the uncoated magnesium plates fixed on the partially osteotomized and intact ribs. CT scans showed no broken plates or implant displacement. The micro-CT examination demonstrated better surrounding bone properties around the coated than the uncoated magnesium implants 12 weeks after surgery. No negative influence of magnesium degradation on bone healing was observed with histological examinations. Plastic deformation during surgery and cyclic deformation did not affect the integrity of the used magnesium plates. This study showed promising results for the further development of coated magnesium plate/screw systems for bone fixation. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

In Vitro and In Vivo Evaluations of Nano-Hydroxyapatite/Polyamide 66/Glass Fibre (n-HA/PA66/GF) as a Novel Bioactive Bone Screw

PubMed Central

Su, Bao; Peng, Xiaohua; Jiang, Dianming; Wu, Jun; Qiao, Bo; Li, Weichao; Qi, Xiaotong

2013-01-01

In this study, we prepared nano-hydroxyapatite/polyamide 66/glass fibre (n-HA/PA66/GF) bioactive bone screws. The microstructure, morphology and coating of the screws were characterised, and the adhesion, proliferation and viability of MC3T3-E1 cells on n-HA/PA66/GF scaffolds were determined using scanning electron microscope, CCK-8 assays and cellular immunofluorescence analysis. The results confirmed that n-HA/PA66/GF scaffolds were biocompatible and had no negative effect on MC3T3-E1 cells in vitro. To investigate the in vivo biocompatibility, internal fixation properties and osteogenesis of the bioactive screws, both n-HA/PA66/GF screws and metallic screws were used to repair intercondylar femur fractures in dogs. General photography, CT examination, micro-CT examination, histological staining and biomechanical assays were performed at 4, 8, 12 and 24 weeks after operation. The n-HA/PA66/GF screws exhibited good biocompatibility, high mechanical strength and extensive osteogenesis in the host bone. Moreover, 24 weeks after implantation, the maximum push-out load of the bioactive screws was greater than that of the metallic screws. As shown by their good cytocompatibility, excellent biomechanical strength and fast formation and ingrowth of new bone, n-HA/PA66/GF screws are thus suitable for orthopaedic clinical applications. PMID:23861888

Simulation of mechanical behavior and optimization of simulated injection molding process for PLA based antibacterial composite and nanocomposite bone screws using central composite design.

PubMed

Heidari, Behzad Shiroud; Oliaei, Erfan; Shayesteh, Hadi; Davachi, Seyed Mohammad; Hejazi, Iman; Seyfi, Javad; Bahrami, Mozhgan; Rashedi, Hamid

2017-01-01

In this study, injection molding of three poly lactic acid (PLA) based bone screws was simulated and optimized through minimizing the shrinkage and warpage of the bone screws. The optimization was carried out by investigating the process factors such as coolant temperature, mold temperature, melt temperature, packing time, injection time, and packing pressure. A response surface methodology (RSM), based on the central composite design (CCD), was used to determine the effects of the process factors on the PLA based bone screws. Upon applying the method of maximizing the desirability function, optimization of the factors gave the lowest warpage and shrinkage for nanocomposite PLA bone screw (PLA9). Moreover, PLA9 has the greatest desirability among the selected materials for bone screw injection molding. Meanwhile, a finite element analysis (FE analysis) was also performed to determine the force values and concentration points which cause yielding of the screws under certain conditions. The Von-Mises stress distribution showed that PLA9 screw is more resistant against the highest loads as compared to the other ones. Finally, according to the results of injection molding simulations, the design of experiments (DOE) and structural analysis, PLA9 screw is recommended as the best candidate for the production of biomedical materials among all the three types of screws. Copyright © 2016 Elsevier Ltd. All rights reserved.

Radiological, histological, and hematological evaluation of hydroxyapatite-coated resorbable magnesium alloy screws placed in rabbit tibia.

PubMed

Lim, Ho-Kyung; Byun, Soo-Hwan; Lee, Jin-Yong; Lee, Jung-Woo; Kim, Sae-Mi; Lee, Sung-Mi; Kim, Hyoun-Ee; Lee, Jong-Ho

2017-08-01

Titanium (Ti) screw has excellent mechanical property, and osseointegration capacity. However, they require surgery for removal. In contrast, polymer screws are resorbable, but they have poor mechanical properties. In this research, magnesium alloy screws (WE43: Mg-Y-Nd-Zr) that have advantages of titanium and polymer were manufactured. In addition, to increase biocompatibility and control degradation rate, the Mg alloy was coated with hydroxyapatite (HA). Torsion test and corrosion test were performed in vitro. For clinical, radiological and histological evaluation, on the eight rabbits, two HA-coated screws were installed in left tibia, and two noncoated screws were installed in right tibia. Each four rabbits were sacrificed 6 and 12 weeks postoperatively. For hematological evaluation, the same type of screws were installed on both legs. Complete blood count (CBC), Mg 2+ concentrate were sampled from the ear central artery on the operation day for a control point, and at 1, 2, 4, 6, 8, and 12 weeks. Mg alloy screws have no differences of biocompatibility according to the HA coating. However, resorption of screw was slower in case of the HA coating. The hematological problem related releasing of Mg was not found. The results suggest that Mg alloy screws have feasibility for clinical application. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1636-1644, 2017. © 2016 Wiley Periodicals, Inc.

First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability.

PubMed

Politi, Joel; John, Hayes; Njus, Glen; Bennett, Gordon L; Kay, David B

2003-04-01

First metatarsal phalangeal joint (MTP) arthrodesis is a commonly performed procedure for the treatment of hallux rigidus, severe and recurrent bunion deformities, rheumatoid arthritis and other less common disorders of the joint. There are different techniques of fixation of the joint to promote arthrodesis including oblique lag screw fixation, lag screw and dorsal plate fixation, crossed Kirschner wires, dorsal plate fixation alone and various types of external fixation. Ideally the fixation method should be reproducible, lead to a high rate of fusion, and have a low incidence of complications. In the present study, we compared the strength of fixation of five commonly utilized techniques of first MTP joint arthrodesis. These were: 1. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical interfragmentary lag screw. 2. Surface excision with machined conical reaming and fixation with crossed 0.062 Kirschner wires. 3. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical lag screw and a four hole dorsal miniplate secured with 3.5 mm cortical screws. 4. Surface excision with machined conical reaming and fixation with a four hole dorsal miniplate secured with 3.5 mm cortical screws and no lag screw. 5. Planar surface excision and fixation with a single oblique 3.5 mm interfragmentary cortical lag screw. Testing was done on an Instron materials testing device loading the first MTP joint in dorsiflexion. Liquid metal strain gauges were placed over the joint and micromotion was detected with varying loads and cycles. The most stable technique was the combination of machined conical reaming and an oblique interfragmentary lag screw and dorsal plate. This was greater than two times stronger than an oblique lag screw alone. Dorsal plate alone and Kirschner wire fixation were the weakest techniques. First MTP fusion is a commonly performed procedure for the treatment of a variety of disorders of the first MTP joint. The most stable technique for obtaining fusion in this study was the combination of an oblique lag screw and a dorsal plate. This should lead to higher rates of arthrodesis.

Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation.

PubMed

Sabonghy, Eric Peter; Wood, Robert Michael; Ambrose, Catherine Glauber; McGarvey, William Christopher; Clanton, Thomas Oscar

2003-03-01

Tendon transfer techniques in the foot and ankle are used for tendon ruptures, deformities, and instabilities. This fresh cadaver study compares the tendon fixation strength in 10 paired specimens by performing a tendon to tendon fixation technique or using 7 x 20-25 mm bioabsorbable interference-fit screw tendon fixation technique. Load at failure of the tendon to tendon fixation method averaged 279N (Standard Deviation 81N) and the bioabsorbable screw 148N (Standard Deviation 72N) [p = 0.0008]. Bioabsorbable interference-fit screws in these specimens show decreased fixation strength relative to the traditional fixation technique. However, the mean bioabsorbable screw fixation strength of 148N provides physiologic strength at the tendon-bone interface.

Salmon Supplementation Studies in Idaho Rivers, 1999-2000 Progress Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kohler, Andy; Taki, Doug; Teton, Angelo

2001-11-01

As part of the Idaho Supplementation Studies, fisheries crews from the Shoshone-Bannock Tribes have been snorkeling tributaries of the Salmon River to estimate chinook salmon (Oncorhynchus tshawytscha) parr abundance; conducting surveys of spawning adult chinook salmon to determine the number of redds constructed and collect carcass information; operating a rotary screw trap on the East Fork Salmon River and West Fork Yankee Fork Salmon River to enumerate and PIT-tag emigrating juvenile chinook salmon; and collecting and PIT-tagging juvenile chinook salmon on tributaries of the Salmon River. The Tribes work in the following six tributaries of the Salmon River: Bear Valleymore » Creek, East Fork Salmon River, Herd Creek, South Fork Salmon River, Valley Creek, and West Fork Yankee Fork Salmon River. Snorkeling was used to obtain parr population estimates for ISS streams from 1992 to 1997. However, using the relatively vigorous methods described in the ISS experimental design to estimate summer chinook parr populations, results on a project-wide basis showed extraordinarily large confidence intervals and coefficients of variation. ISS cooperators modified their sampling design over a few years to reduce the variation around parr population estimates without success. Consequently, in 1998 snorkeling to obtain parr population estimates was discontinued and only General Parr Monitoring (GPM) sites are snorkeled. The number of redds observed in SBT-ISS streams has continued to decline as determined by five year cycles. Relatively weak strongholds continue to occur in the South Fork Salmon River and Bear Valley Creek. A rotary screw trap was operated on the West Fork Yankee Fork during the spring and fall of 1999 and the spring of 2000 to monitor juvenile chinook migration. A screw trap was also operated on the East Fork of the Salmon River during the spring and fall from 1993 to 1997 and 1999 (fall only) to 2000. Significant supplementation treatments have occurred in the South Fork Salmon River (IDFG). The East Fork Salmon River received supplementation treatments yearly through 1995. There have been no treatments since 1995, and no significant future treatments from local broodstock are conceivable due to extremely poor escapement. The West Fork Yankee Fork received a single presmolt treatment in 1994. Similarly, no significant future treatments are planned for the WFYF due to extremely poor escapement. However, small scale experimental captive rearing and broodstock techniques are currently being tested with populations from the EFSR and WFYF. Captive rearing/broodstock techniques could potentially provide feedback for evaluation of supplementation. The other three SBT-ISS streams are control streams and do not receive hatchery treatments.« less

Juvenile salmonid monitoring in the White Salmon River, Washington, post-Condit Dam removal, 2016

USGS Publications Warehouse

Jezorek, Ian G.; Hardiman, Jill M.

2017-06-23

Condit Dam, at river kilometer 5.3 on the White Salmon River, Washington, was breached in 2011 and removed completely in 2012, allowing anadromous salmonids access to habitat that had been blocked for nearly 100 years. A multi-agency workgroup concluded that the preferred salmonid restoration alternative was natural recolonization with monitoring to assess efficacy, followed by a management evaluation 5 years after dam removal. Limited monitoring of salmon and steelhead spawning has occurred since 2011, but no monitoring of juveniles occurred until 2016. During 2016, we operated a rotary screw trap at river kilometer 2.3 (3 kilometers downstream of the former dam site) from late March through May and used backpack electrofishing during summer to assess juvenile salmonid distribution and abundance. The screw trap captured primarily steelhead (Oncorhynchus mykiss; smolts, parr, and fry) and coho salmon (O. kisutch; smolts and fry). We estimated the number of steelhead smolts at 3,851 (standard error = 1,454) and coho smolts at 1,093 (standard error = 412). In this document, we refer to O. mykiss caught at the screw trap as steelhead because they were actively migrating, but because we did not know migratory status of O. mykiss caught in electrofishing surveys, we simply refer to them as O. mykiss or steelhead/rainbow trout. Steelhead and coho smolts tagged with passive integrated transponder tags were subsequently detected downstream at Bonneville Dam on the Columbia River. Few Chinook salmon (O. tshawytscha) fry were captured, possibly as a result of trap location or effects of a December 2015 flood. Sampling in Mill, Buck, and Rattlesnake Creeks (all upstream of the former dam site) showed that juvenile coho were present in Mill and Buck Creeks, suggesting spawning had occurred there. We compared O. mykiss abundance data in sites on Buck and Rattlesnake Creeks to pre-dam removal data. During 2016, age-0 O. mykiss were more abundant in Buck Creek than in 2009 or 2010, though age-1 and older O. mykiss abundance was similar. In Rattlesnake Creek, age-0 O. mykiss abundance during 2016 slightly exceeded the mean abundance from 2001 through 2005, although age-1 and older O. mykiss abundance was lower than from 2001 through 2005. These sampling efforts also provided the opportunity to collect genetic samples to investigate parental and stock origin, although funding to analyze the samples was not part of this grant. Juvenile salmonid sampling efforts during 2016 have shown that natural spawning produced steelhead and coho smolts and that coho were colonizing some tributaries. The 2016 efforts also provided the first post-dam juvenile abundance estimates. We hope to continue monitoring to better understand abundance trends, distribution, and life history patterns of recolonizing salmonids in the White Salmon River to assess efficacy of natural recolonization and to inform management decisions.

Single-screw Fixation of Adolescent Salter-II Proximal Humeral Fractures: Biomechanical Analysis of the "One Pass Door Lock" Technique.

PubMed

Miller, Mark Carl; Redman, Christopher N; Mistovich, R Justin; Muriuki, Muturi; Sangimino, Mark J

2017-09-01

Pin fixation of Salter-II proximal humeral fractures in adolescents approaching skeletal maturity has potential complications that can be avoided with single-screw fixation. However, the strength of screw fixation relative to parallel and diverging pin fixation is unknown. To compare the biomechanical fixation strength between these fixation modalities, we used synthetic composite humeri, and then compared these results in composite bone with cadaveric humeri specimens. Parallel pinning, divergent pinning, and single-screw fixation repairs were performed on synthetic composite humeri with simulated fractures. Six specimens of each type were tested in axial loading and other 6 were tested in torsion. Five pair of cadaveric humeri were tested with diverging pins and single screws for comparison. Single-screw fixation was statistically stronger than pin fixation in axial and torsional loading in both composite and actual bone. There was no statistical difference between composite and cadaveric bone specimens. Single-screw fixation can offer greater stability to adolescent Salter-II fractures than traditional pinning. Single-screw fixation should be considered as a viable alternative to percutaneous pin fixation in transitional patients with little expected remaining growth.

Development of a test rig for a helium twin-screw compressor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, B. M.; Hu, Z. J.; Zhang, P.

2014-01-29

A large helium cryogenic system is being developed for use in great science projects, such as the International Thermonuclear Experimental Reactor (ITER), Large Helical Device (LHD), and the Experimental Advanced Superconducting Tokamak (EAST). In this cryogenic system, a twin-screw compressor is a key component. Therefore, it is necessary to obtain the compressor performance. To obtain the performance characteristics, a test rig for the compressor has been built. All the important performance parameters, including adiabatic efficiency, volumetric efficiency, oil injection characteristic, and noise characteristic can be acquired with the rig when sensors are installed in the test system. With the testmore » performance, the helium twin-screw compressor can be evaluated. Using these results, the design of the compressor can be improved.« less

Investigation of process temperature and screw speed on properties of a pharmaceutical solid dispersion using corotating and counter-rotating twin-screw extruders.

PubMed

Keen, Justin M; Martin, Charlie; Machado, Augie; Sandhu, Harpreet; McGinity, James W; DiNunzio, James C

2014-02-01

The use of corotating twin screw hot-melt extruders to prepare amorphous drug/polymer systems has become commonplace. As small molecule drug candidates exiting discovery pipelines trend towards higher MW and become more structurally complicated, the acceptable operating space shifts below the drug melting point. The objective of this research is to investigate the extrusion process space, which should be selected to ensure that the drug is solubilized in the polymer with minimal thermal exposure, is critical in ensuring the performance, stability and purity of the solid dispersion. The properties of a model solid dispersion were investigated using both corotating and counter-rotating hot-melt twin-screw extruders operated at various temperatures and screw speeds. The solid state and dissolution performance of the resulting solid dispersions was investigated and evaluated in context of thermodynamic predictions from Flory-Huggins Theory. In addition, the residence time distributions were measured using a tracer, modelled and characterized. The amorphous content in the resulting solid dispersions was dependent on the combination of screw speed, temperature and operating mode. The counter-rotating extruder was observed to form amorphous solid dispersions at a slightly lower temperature and with a narrower residence time distribution, which also exhibited a more desirable shape. © 2013 Royal Pharmaceutical Society.

Electro-Thermal Simulation Studies of SiC Junction Diodes Containing Screw Dislocations Under High Reverse-Bias Operation

NASA Technical Reports Server (NTRS)

Joshi, R. P.

2001-01-01

The objective of this work was to conduct a modeling study of SiC P-N junction diodes operating under high reverse biased conditions. Analytical models and numerical simulation capabilities were to be developed for self-consistent electro-thermal analysis of the diode current-voltage (I-V) characteristics. Data from GRC indicate that screw dislocations are unavoidable in large area SiC devices, and lead to changes in the SiC diode electrical response characteristics under high field conditions. For example, device instability and failures linked to internal current filamentation have been observed. The physical origin of these processes is not well understood, and quantitative projections of the electrical behavior under high field and temperature conditions are lacking. Thermal calculations for SiC devices have not been reported in the literature either. So estimates or projections of peak device temperatures and power limitations do not exist. This numerical study and simulation analysis was aimed at resolving some of the above issues. The following tasks were successfully accomplished: (1) Development of physically based models using one- and two-dimensional drift-diffusion theory for the transport behavior and I-V characteristics; (2) One- and two-dimensional heat flow to account for internal device heating. This led to calculations of the internal temperature profiles, which in turn, were used to update the electrical transport parameters for a self-consistent analysis. The temperature profiles and the peak values were thus obtainable for a given device operating condition; (3) Inclusion of traps assumed to model the presence of internal screw dislocations running along the longitudinal direction; (4) Predictions of the operating characteristics with and without heating as a function of applied bias with and without traps. Both one and two-dimensional cases were implemented; (5) Assessment of device stability based on the operating characteristics. The presence of internal non-uniformities, particularly filamentary structures, was probed and demonstrated; (6) Cause and physical origins of filamentary behavior and unstable I-V characteristics were made transparent; (7) It was demonstrated that diodes containing defects would be more prone to thermal breakdown associated with the temperature dependent decrease in the thermal conductivity; and (8) Finally, negative differential resistance (S-shaped NDR) which can potential lead to device instability and filamentary behavior was shown to occur for diodes containing a line of defects such as could be associated with a screw dislocation line.

MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results.

PubMed

Blizzard, Daniel J; Thomas, J Alex

2018-03-15

Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon. To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation. Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis. The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded. Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms. The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with intraoperative repositioning and may lead to significant improvements in operative efficiency and cost savings. 4.

Biomechanical analysis of a novel hook-screw technique for C1-2 stabilization.

PubMed

Reis, Marco Túlio; Nottmeier, Eric W; Reyes, Phillip M; Baek, Seungwon; Crawford, Neil R

2012-09-01

The Food and Drug Administration has not cleared the following medical devices for the use described in this study. The following medical devices are being discussed for an off-label use: cervical lateral mass screws. As an alternative for cases in which the anatomy and spatial relationship between C-2 and a vertebral artery precludes insertion of C-2 pedicle/pars or C1-2 transarticular screws, a technique that includes opposing laminar hooks (claw) at C-2 combined with C-1 lateral mass screws may be used. The biomechanical stability of this alternate technique was compared with that of a standard screw-rod technique in vitro. Flexibility tests were performed in 7 specimens (occiput to C-3) in the following 6 different conditions: 1) intact; 2) after creating instability and attaching a posterior cable/graft at C1-2; 3) after removing the graft and attaching a construct comprising C-1 lateral mass screws and C-2 laminar claws; 4) after reattaching the posterior cable-graft at C1-2 (posterior hardware still in place); 5) after removing the posterior cable-graft and laminar hooks and placing C-2 pedicle screws interconnected to C-1 lateral mass screws via rod; and 6) after reattaching the posterior cable-graft at C1-2 (screw-rod construct still in place). All types of stabilization significantly reduced the range of motion, lax zone, and stiff zone compared with the intact condition. There was no significant biomechanical difference in terms of range of motion or lax zone between the screw-rod construct and the screw-claw-rod construct in any direction of loading. The screw-claw-rod technique restricts motion much like the standard Harms technique, making it an acceptable alternative technique when aberrant arterial anatomy precludes the placement of C-2 pars/pedicle screws or C1-2 transarticular screws.

SU-E-T-609: Perturbation Effects of Pedicle Screws On Radiotherapy Dose Distributions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bar-Deroma, R; Borzov, E; Nevelsky, A

2015-06-15

Purpose: Radiation therapy in conjunction with surgical implant fixation is a common combined treatment in case of bone metastases. However, metal implants generally used in orthopedic implants perturb radiation dose distributions. Carbon-Fiber Reinforced (CFR) PEEK material has been recently introduced for production of intramedullary screws and plates. Gold powder can be added to the CFR-PEEK material in order to enhance visibility of the screws during intraoperative imaging procedures. In this work, we investigated the perturbation effects of the pedicle screws made of CFR-PEEK, CFR-PEEK with added gold powder (CFR-PEEK-AU) and Titanium (Ti) on radiotherapy dose distributions. Methods: Monte Carlo (MC)more » simulations were performed using the EGSnrc code package for 6MV beams with 10×10 fields at SSD=100cm. By means of MC simulations, dose distributions around titanium, CFR- PEEK and CFR-PEEK-AU screws (manufactured by Carbo-Fix Orthopedics LTD, Israel) placed in a water phantom were calculated. The screw axis was either parallel or perpendicular to the beam axis. Dose perturbation (relative to dose in homogeneous water phantom) was assessed. Results: Maximum overdose due to backscatter was 10% for the Ti screws, 5% for the CFR-PEEK-AU screws and effectively zero for the CFR-PEEK screws. Maximum underdose due to attenuation was 25% for the Ti screws, 15% for the CFR-PEEK-AU screws and 5% for the CFR-PEEK screws. Conclusion: Titanium screws introduce the largest distortion on the radiation dose distribution. The gold powder added to the CFR-PEEK material improves visibility at the cost of increased dose perturbation. CFR-PEEK screws caused minimal alteration on the dose distribution. This can decrease possible over and underdose of adjacent tissue and thus favorably influence treatment efficiency. The use of such implants has potential clinical advantage in the treatment of neoplastic bone disease.« less

Fate of the syndesmotic screw--Search for a prudent solution.

PubMed

Kaftandziev, Igor; Spasov, Marko; Trpeski, Simon; Zafirova-Ivanovska, Beti; Bakota, Bore

2015-11-01

Ankle fractures are common injuries. Since the recognition of the importance of syndesmotic injury in ankle fractures, much of the scientific work has been focused on concomitant syndesmotic injury. Despite the invention of novel devices for restoration and maintenance of the congruent syndesmosis following syndesmotic injury, the metallic syndesmotic screw is still considered to be the "gold standard". The aim of this study was to compare the clinical results in patients who retained the syndesmosis screw with those in whom the screw was removed following open reduction and internal fixation of the malleolar fracture associated with syndesmosis disruption. This was a retrospective study of 82 patients. Minimum follow-up was 12 months. Clinical evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) for patient general satisfaction. The condition of the screw (removed, intact or broken), presence of radiolucency around the syndesmotic screw and the tibiofibular clear space were recorded using final follow-up radiographs. Three cortices were engaged in 66 patients (80%) and quadricortical fixation was performed in the remaining 16 patients (20%). The number of engaged cortices did not correlate with the clinical outcome and screw fracture. A single syndesmotic screw was used in 71 patients (86%. The mean AOFAS score in the group with intact screw (I) was 83; the scores in the group with broken screw (B) and removed screw (R) were 92.5 and 85.5, respectively. There was a statistically significant difference between the three groups: this was due to the difference between groups I and B; the difference between groups I and R and groups B and R were not statistically significant. There were no statistically significant differences in VAS results. There were no statistically significant differences in clinical outcome between the group with the screw retained and the group in which the screw was removed; however, the group with broken screws had the best clinical outcome based on AOFAS score. Widening of the syndesmosis after screw removal was not evident. We do not recommend routine syndesmosis screw removal. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 3: Preload and tensile fracture load testing.

PubMed

Al Jabbari, Youssef S; Fournelle, Raymond; Ziebert, Gerald; Toth, Jeffrey; Iacopino, Anthony M

2008-04-01

The aim of this study was to determine the preload and tensile fracture load values of prosthetic retaining screws after long-term use in vivo compared to unused screws (controls). Additionally, the investigation addressed whether the preload and fracture load values of prosthetic retaining screws reported by the manufacturer become altered after long-term use in vivo. For preload testing, 10 new screws (controls) from Nobel Biocare (NB) and 73 used retaining screws [58 from NB and 15 from Sterngold (SG)] were subjected to preload testing. For tensile testing, eight controls from NB and 58 used retaining screws (46 from NB and 12 from SG) were subjected to tensile testing. Used screws for both tests were in service for 18-120 months. A custom load frame, load cell, and torque wrench setup were used for preload testing. All 83 prosthetic screws were torqued once to 10 Ncm, and the produced preload value was recorded (N) using an X-Y plotter. Tensile testing was performed on a universal testing machine and the resulting tensile fracture load value was recorded (N). Preload and tensile fracture load values were analyzed with 2-way ANOVA and Tukey post-hoc tests. There was a significant difference between preload values for screws from NB and screws from SG (p < 0.001). The preload values for gold alloy screws from NB decreased as the number of years in service increased. There was a significant difference between tensile fracture values for the three groups (gold alloy screws from NB and SG and palladium alloy screws from NB) at p < 0.001. The tensile fracture values for gold alloy screws from NB and SG decreased as the number of years in service increased. In fixed detachable hybrid prostheses, perhaps as a result of galling, the intended preload values of prosthetic retaining screws may decrease with increased in-service time. The reduction of the fracture load value may be related to the increase of in-service time; however, the actual determination of this relationship is not possible from this study alone.

Visualization and understanding of the granulation liquid mixing and distribution during continuous twin screw granulation using NIR chemical imaging.

PubMed

Vercruysse, Jurgen; Toiviainen, Maunu; Fonteyne, Margot; Helkimo, Niko; Ketolainen, Jarkko; Juuti, Mikko; Delaet, Urbain; Van Assche, Ivo; Remon, Jean Paul; Vervaet, Chris; De Beer, Thomas

2014-04-01

Over the last decade, there has been increased interest in the application of twin screw granulation as a continuous wet granulation technique for pharmaceutical drug formulations. However, the mixing of granulation liquid and powder material during the short residence time inside the screw chamber and the atypical particle size distribution (PSD) of granules produced by twin screw granulation is not yet fully understood. Therefore, this study aims at visualizing the granulation liquid mixing and distribution during continuous twin screw granulation using NIR chemical imaging. In first instance, the residence time of material inside the barrel was investigated as function of screw speed and moisture content followed by the visualization of the granulation liquid distribution as function of different formulation and process parameters (liquid feed rate, liquid addition method, screw configuration, moisture content and barrel filling degree). The link between moisture uniformity and granule size distributions was also studied. For residence time analysis, increased screw speed and lower moisture content resulted to a shorter mean residence time and narrower residence time distribution. Besides, the distribution of granulation liquid was more homogenous at higher moisture content and with more kneading zones on the granulator screws. After optimization of the screw configuration, a two-level full factorial experimental design was performed to evaluate the influence of moisture content, screw speed and powder feed rate on the mixing efficiency of the powder and liquid phase. From these results, it was concluded that only increasing the moisture content significantly improved the granulation liquid distribution. This study demonstrates that NIR chemical imaging is a fast and adequate measurement tool for allowing process visualization and hence for providing better process understanding of a continuous twin screw granulation system. Copyright © 2013 Elsevier B.V. All rights reserved.

Anomalous Quasiparticle Symmetries and Non-Abelian Defects on Symmetrically Gapped Surfaces of Weak Topological Insulators.

PubMed

Mross, David F; Essin, Andrew; Alicea, Jason; Stern, Ady

2016-01-22

We show that boundaries of 3D weak topological insulators can become gapped by strong interactions while preserving all symmetries, leading to Abelian surface topological order. The anomalous nature of weak topological insulator surfaces manifests itself in a nontrivial action of symmetries on the quasiparticles; most strikingly, translations change the anyon types in a manner impossible in strictly 2D systems with the same symmetry. As a further consequence, screw dislocations form non-Abelian defects that trap Z_{4} parafermion zero modes.

Effectiveness of the surgical torque limiter: a model comparing drill- and hand-based screw insertion into locking plates.

PubMed

Ioannou, Christopher; Knight, Matthew; Daniele, Luca; Flueckiger, Lee; Tan, Ezekiel S L

2016-10-17

The objective of this study is to analyse the effectiveness of the surgical torque limiter during operative use. The study also investigates the potential differences in torque between hand and drill-based screw insertion into locking plates using a standardised torque limiter. Torque for both hand and power screw insertion was measured through a load cell, registering 6.66 points per second. This was performed in a controlled environment using synthetic bone, a locking plate and locking screws to simulate plate fixation. Screws were inserted by hand and by drill with torque values measured. The surgical torque limiter (1.5 Nm) was effective as the highest recorded reading in the study was 1.409 Nm. Comparatively, there is a statistically significant difference between screw insertion methods. Torque produced for manually driven screw insertion into locking plates was 1.289 Nm (95 % CI 1.269-1.308) with drill-powered screw insertion at 0.740 Nm (95 % CI 0.723-0.757). The surgical torque limiter proved to be effective as per product specifications. Screws inserted under power produce significantly less torque when compared to manual insertion by hand. This is likely related to the mechanism of the torque limiter when being used at higher speeds for which it was designed. We conclude that screws may be inserted using power to the plate with the addition of a torque limiter. It is recommended that all screws inserted by drill be hand tightened to achieve adequate torque values.

Enhanced bone screw fixation with biodegradable bone cement in osteoporotic bone model.

PubMed

Juvonen, Tiina; Koistinen, Arto; Kröger, Heikki; Lappalainen, Reijo

2012-09-27

The purpose of this study was to study the potential of novel biodegradable PCL bone cement to improve bone screw fixation strength in osteoporotic bone. The biomechanical properties of bone cement (ε-polycaprolactone, PCL) and fixation strength were studied using biomechanical tests and bone screws fixed in an osteoporotic bone model. Removal torques and pullout strengths were assessed for cortical, self-tapping, and cancellous screws inserted in the osteoporotic bone model (polyurethane foam blocks with polycarbonate plate) with and without PCL bone cement. Open cell and cellular rigid foam blocks with a density of 0.12 g/cm3 were used in this model. Removal torques were significantly (more than six-fold) improved with bone cement for cancellous screws. Furthermore, the bone cement improved pullout strengths three to 12 times over depending on the screw and model material. Biodegradable bone cement turned out to be a very potential material to stabilize screw fixation in osteoporotic bone. The results warrant further research before safe clinical use, especially to clarify clinically relevant factors using real osteoporotic bone under human body conditions and dynamic fatigue testing for long-term performance.

Axial loading screw fixation for chevron type osteotomies of the distal first metatarsal: a retrospective outcomes analysis.

PubMed

Murphy, Ryan M; Fallat, Lawrence M; Kish, John P

2014-01-01

The distal chevron osteotomy is a widely accepted technique for the treatment of hallux abductovalgus deformity. Although the osteotomy is considered to be stable, displacements of the capital fragment has been described. We propose a new method for fixation of the osteotomy involving the axial loading screw (ALS) used in addition to single screw fixation. We believe this method will provide a more mechanically stable construct. We reviewed the charts of 46 patients in whom 52 feet underwent a distal chevron osteotomy that was fixated with either 1 screw or 2 screws that included the ALS. We hypothesized that the ALS group would have fewer displacements and would heal more quickly than the single screw fixation group. We found that the group with ALS fixation had healed at a mean of 6.5 weeks and that the group with single screw fixation had healed at 9.53 weeks (p = .001). Also, 8 cases occurred of displacement of the capital fragment in the single screw, control group compared with 2 cases of displacement in the ALS group. However, this finding was not statistically significant. The addition of the ALS to single screw fixation allowed the patients to heal approximately 3 weeks earlier than single screw fixation alone. The ALS is a fixation option for the surgeon to consider when osseous correction of hallux abducto valgus is performed. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of Real-Time Feedback on Screw Placement Into Synthetic Cancellous Bone.

PubMed

Gustafson, Peter A; Geeslin, Andrew G; Prior, David M; Chess, Joseph L

2016-08-01

The objective of this study is to evaluate whether real-time torque feedback may reduce the occurrence of stripping when inserting nonlocking screws through fracture plates into synthetic cancellous bone. Five attending orthopaedic surgeons and 5 senior level orthopaedic residents inserted 8 screws in each phase. In phase I, screws were inserted without feedback simulating conventional techniques. In phase II, screws were driven with visual torque feedback. In phase III, screws were again inserted with conventional techniques. Comparison of these 3 phases with respect to screw insertion torque, surgeon rank, and perception of stripping was used to establish the effects of feedback. Seventy-three of 239 screws resulted in stripping. During the first phase, no feedback was provided and the overall strip rate was 41.8%; this decreased to 15% with visual feedback (P < 0.001) and returned to 35% when repeated without feedback. With feedback, a lower average torque was applied over a narrower torque distribution. Residents stripped 40.8% of screws compared with 20.2% for attending surgeons. Surgeons were poor at perceiving whether they stripped. Prevention and identification of stripping is influenced by surgeon perception of tactile sensation. This is significantly improved with utilization of real-time visual feedback of a torque versus roll curve. This concept of real-time feedback seems beneficial toward performance in synthetic cancellous bone and may lead to improved fixation in cancellous bone in a surgical setting.

Spinal intra-operative three-dimensional navigation with infra-red tool tracking: correlation between clinical and absolute engineering accuracy

NASA Astrophysics Data System (ADS)

Guha, Daipayan; Jakubovic, Raphael; Gupta, Shaurya; Yang, Victor X. D.

2017-02-01

Computer-assisted navigation (CAN) may guide spinal surgeries, reliably reducing screw breach rates. Definitions of screw breach, if reported, vary widely across studies. Absolute quantitative error is theoretically a more precise and generalizable metric of navigation accuracy, but has been computed variably and reported in fewer than 25% of clinical studies of CAN-guided pedicle screw accuracy. We reviewed a prospectively-collected series of 209 pedicle screws placed with CAN guidance to characterize the correlation between clinical pedicle screw accuracy, based on postoperative imaging, and absolute quantitative navigation accuracy. We found that acceptable screw accuracy was achieved for significantly fewer screws based on 2mm grade vs. Heary grade, particularly in the lumbar spine. Inter-rater agreement was good for the Heary classification and moderate for the 2mm grade, significantly greater among radiologists than surgeon raters. Mean absolute translational/angular accuracies were 1.75mm/3.13° and 1.20mm/3.64° in the axial and sagittal planes, respectively. There was no correlation between clinical and absolute navigation accuracy, in part because surgeons appear to compensate for perceived translational navigation error by adjusting screw medialization angle. Future studies of navigation accuracy should therefore report absolute translational and angular errors. Clinical screw grades based on post-operative imaging, if reported, may be more reliable if performed in multiple by radiologist raters.

The Free-Hand Technique for S2-Alar-Iliac Screw Placement: A Safe and Effective Method for Sacropelvic Fixation in Adult Spinal Deformity.

PubMed

Shillingford, Jamal N; Laratta, Joseph L; Tan, Lee A; Sarpong, Nana O; Lin, James D; Fischer, Charla R; Lehman, Ronald A; Kim, Yongjung J; Lenke, Lawrence G

2018-02-21

Spinopelvic fixation is an integral part of achieving solid fusion across the lumbosacral junction, especially in deformity procedures requiring substantial correction or long-segment constructs. Traditional S2-alar-iliac (S2AI) screw-placement techniques utilize fluoroscopy, increasing operative time and radiation exposure to the patient and surgeon. We describe a novel free-hand technique for S2AI screw placement in patients with adult spinal deformity. We reviewed the records of 45 consecutive patients who underwent spinopelvic fixation performed with use of S2AI screws by the senior surgeon and various fellows or residents over a 12-month period (2015 to 2016). In each case, the S2AI screws were placed utilizing a free-hand technique without fluoroscopic or image guidance. Screw position and accuracy were assessed by intraoperative O-arm imaging and analyzed using 3-dimensional interactive manipulation of computed tomography images. A total of 100 screws were placed, 51 by the senior surgeon and 49 by trainees. The mean patient age was 57.4 ± 12.7 years at the time of surgery; 37 (82.2%) of the patients were female. Preoperative diagnoses included adult idiopathic scoliosis (n = 19), adult degenerative scoliosis (n = 15), flatback syndrome (n = 2), fixed sagittal imbalance (n = 6), and distal junctional kyphosis (n = 3). Five (5%) of the screws were placed with moderate to severe cortical breaches, all of which perforated the pelvis posteriorly, with no clinically notable neurovascular or visceral complications. The breach rate did not differ significantly between the senior surgeon and trainees. The free-hand technique for S2AI screw placement, when performed in a standardized manner, was demonstrated to be safe and reliable in constructs requiring spinopelvic fixation. The accuracy of screw placement relies on visible and palpable anatomic landmarks that obviate the need for intraoperative fluoroscopy or image guidance, potentially reducing operative time and radiation exposure. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures.

PubMed

Röderer, Götz; Scola, Alexander; Schmölz, Werner; Gebhard, Florian; Windolf, Markus; Hofmann-Fliri, Ladina

2013-10-01

Proximal humerus fracture fixation can be difficult because of osteoporosis making it difficult to achieve stable implant anchorage in the weak bone stock even when using locking plates. This may cause implant failure requiring revision surgery. Cement augmentation has, in principle, been shown to improve stability. The aim of this study was to investigate whether augmentation of particular screws of a locking plate aimed at a region of low bone quality is effective in improving stability in a proximal humerus fracture model. Twelve paired human humerus specimens were included. Quantitative computed tomography was performed to determine bone mineral density (BMD). Local bone quality in the direction of the six proximal screws of a standard locking plate (PHILOS, Synthes) was assessed using mechanical means (DensiProbe™). A three-part fracture model with a metaphyseal defect was simulated and fixed with the plate. Within each pair of humeri the two screws aimed at the region of the lowest bone quality according to the DensiProbe™ were augmented in a randomised manner. For augmentation, 0.5 ml of bone cement was injected in a screw with multiple outlets at its tip under fluoroscopic control. A cyclic varus-bending test with increasing upper load magnitude was performed until failure of the screw-bone fixation. The augmented group withstood significantly more load cycles. The correlation of BMD with load cycles until failure and BMD with paired difference in load cycles to failure showed that augmentation could compensate for a low BMD. The results demonstrate that augmentation of screws in locked plating in a proximal humerus fracture model is effective in improving primary stability in a cyclic varus-bending test. The augmentation of two particular screws aimed at a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. Copyright © 2013 Elsevier Ltd. All rights reserved.

Anterior transarticular C1-C2 fixation with contralateral screw insertion: a report of two cases and technical note.

PubMed

Lvov, Ivan; Grin, Andrey; Kaykov, Aleksandr; Smirnov, Vladimir; Krylov, Vladimir

2017-08-08

Anterior transarticular fixation of the C1-C2 vertebrae is a well-known technique that involves screw insertion through the body of the C2 vertebra into the lateral masses of the atlas through an anterior transcervical approach. Meanwhile, contralateral screw insertion has been previously described only in anatomical studies. We describe two case reports of the clinical application of this new technique. In Case 1, the patient was diagnosed with an unstable C1 fracture. The clinical features of the case did not allow for any type of posterior atlantoaxial fusion, Halo immobilization, or routine anterior fixation using the Reindl and Koller techniques. The possible manner of screw insertion into the anterior third of the right lateral mass was via a contralateral trajectory, which was performed in this case. Case 2 involved a patient with neglected posteriorly dislocated dens fracture who could not lie in the prone position due to concomitant cardiac pathology. Reduction of atlantoaxial dislocation was insufficient, even after scar tissue resection at the fracture, while transdental fusion was not possible. Considering the success of the previous case, atlantoaxial fixation was performed through the small approach, using the Reindl technique and contralateral screw insertion. These two cases demonstrate the potential of anterior transarticular fixation of C1-C2 vertebrae in cases where posterior atlantoaxial fusion is not achievable. This type of fixation can be performed through a single approach if one screw is inserted using the Reindl technique and another is inserted via a contralateral trajectory.

A Biomechanical Analysis of 2 Constructs for Metacarpal Spiral Fracture Fixation in a Cadaver Model: 2 Large Screws Versus 3 Small Screws.

PubMed

Eu-Jin Cheah, Andre; Behn, Anthony W; Comer, Garet; Yao, Jeffrey

2017-12-01

Surgeons confronted with a long spiral metacarpal fracture may choose to fix it solely with lagged screws. A biomechanical analysis of a metacarpal spiral fracture model was performed to determine whether 3 1.5-mm screws or 2 2.0-mm screws provided more stability during bending and torsional loading. Second and third metacarpals were harvested from 12 matched pairs of fresh-frozen cadaveric hands and spiral fractures were created. One specimen from each matched pair was fixed with 2 2.0-mm lagged screws whereas the other was fixed with 3 1.5-mm lagged screws. Nine pairs underwent combined cyclic cantilever bending and axial compressive loading followed by loading to failure. Nine additional pairs were subjected to cyclic external rotation while under a constant axial compressive load and were subsequently externally rotated to failure under a constant axial compressive load. Paired t tests were used to compare cyclic creep, stiffness, displacement, rotation, and peak load levels. Average failure torque for all specimens was 7.2 ± 1.7 Nm. In cyclic torsional testing, the group with 2 screws exhibited significantly less rotational creep than the one with 3 screws. A single specimen in the group with 2 screws failed before cyclic bending tests were completed. No other significant differences were found between test groups during torsional or bending tests. Both constructs were biomechanically similar except that the construct with 2 screws displayed significantly less loosening during torsional cyclic loading, although the difference was small and may not be clinically meaningful. Because we found no obvious biomechanical advantage to using 3 1.5-mm lagged screws to fix long spiral metacarpal fractures, the time efficiency and decreased implant costs of using 2-2.0 mm lagged screws may be preferred. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Bioactive ceramic coating of cancellous screws improves the osseointegration in the cancellous bone.

PubMed

Lee, Jae Hyup; Nam, Hwa; Ryu, Hyun-Seung; Seo, Jun-Hyuk; Chang, Bong-Soon; Lee, Choon-Ki

2011-05-01

A number of methods for coating implants with bioactive ceramics have been reported to improve osseointegration in bone, but the effects of bioactive ceramic coatings on the osseointegration of cancellous screws are not known. Accordingly, biomechanical and histomorphometric analyses of the bone-screw interface of uncoated cancellous screws and cancellous screws coated with four different bioactive ceramics were performed. After coating titanium alloy cancellous screws with calcium pyrophosphate (CPP), CaO-SiO(2)-B(2)O(3) glass-ceramics (CSG), apatite-wollastonite 1:3 glass-ceramics (W3G), and CaO-SiO(2)-P(2)O(5)-B(2)O(3) glass-ceramics (BGS-7) using an enameling method, the coated and the uncoated screws were inserted into the proximal tibia and distal femur metaphysis of seven male mongrel dogs. The torque values of the screws were measured at the time of insertion and at removal after 8 weeks. The bone-screw contact ratio was analyzed by histomorphometry. There was no significant difference in the insertion torque between the uncoated and coated screws. The torque values of the CPP and BGS-7 groups measured at removal after 8 weeks were significantly higher than those of the uncoated group. Moreover, the values of the CPP and BGS-7 groups were significantly higher than the insertion torques. The fraction of bone-screw interface measured from the undecalcified histological slide showed that the CPP, W3G, and BGS-7 groups had significantly higher torque values in the cortical bone area than the uncoated group, and the CPP and BGS-7 groups had significantly higher torque values in the cancellous bone area than the uncoated group. In conclusion, a cancellous screw coated with CPP and BGS-7 ceramic bonds directly to cancellous bone to improve the bone-implant osseointegration. This may broaden the indications for cancellous screws by clarifying their contribution to improving osseointegration, even in the cancellous bone area.

In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique.

PubMed

Matsukawa, Keitaro; Yato, Yoshiyuki; Kato, Takashi; Imabayashi, Hideaki; Asazuma, Takashi; Nemoto, Koichi

2014-02-15

The insertional torque of pedicle screws using the cortical bone trajectory (CBT) was measured in vivo. To investigate the effectiveness of the CBT technique by measurement of the insertional torque. The CBT follows a mediolateral and caudocephalad directed path, engaging with cortical bone maximally from the pedicle to the vertebral body. Some biomechanical studies have demonstrated favorable characteristics of the CBT technique in cadaveric lumbar spine. However, no in vivo study has been reported on the mechanical behavior of this new trajectory. The insertional torque of pedicle screws using CBT and traditional techniques were measured intraoperatively in 48 consecutive patients. A total of 162 screws using the CBT technique and 36 screws using the traditional technique were compared. In 8 of 48 patients, the side-by-side comparison of 2 different insertional techniques for each vertebra were performed, which formed the H group. In addition, the insertional torque was correlated with bone mineral density. The mean maximum insertional torque of CBT screws and traditional screws were 2.49 ± 0.99 Nm and 1.24 ± 0.54 Nm, respectively. The CBT screws showed 2.01 times higher torque and the difference was significant between the 2 techniques (P < 0.01). In the H group, the insertional torque were 2.71 ± 1.36 Nm in the CBT screws and 1.58 ± 0.44 Nm in the traditional screws. The CBT screws demonstrated 1.71 times higher torque and statistical significance was achieved (P < 0.01). Positive linear correlations between maximum insertional torque and bone mineral density were found in both technique, the correlation coefficient of traditional screws (r = 0.63, P < 0.01) was higher than that of the CBT screws (r = 0.59, P < 0.01). The insertional torque using the CBT technique is about 1.7 times higher than the traditional technique. 2.

Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide.

PubMed

Kawaguchi, Yoshiharu; Nakano, Masato; Yasuda, Taketoshi; Seki, Shoji; Hori, Takeshi; Kimura, Tomoatsu

2012-11-01

We developed a new technique for cervical pedicle screw and Magerl screw insertion using a 3-dimensional image guide. In posterior cervical spinal fusion surgery, instrumentation with screws is virtually routine. However, malpositioning of screws is not rare. To avoid complications during cervical pedicle screw and Magerl screw insertion, the authors developed a new technique which is a mold shaped to fit the lamina. Cervical pedicle screw fixation and Magerl screw fixation provide good correction of cervical alignment, rigid fixation, and a high fusion rate. However, malpositioning of screws is not a rare occurrence, and thus the insertion of screws has a potential risk of neurovascular injury. It is necessary to determine a safe insertion procedure for these screws. Preoperative computed tomographic (CT) scans of 1-mm slice thickness were obtained of the whole surgical area. The CT data were imported into a computer navigation system. We developed a 3-dimensional full-scale model of the patient's spine using a rapid prototyping technique from the CT data. Molds of the left and right sides at each vertebra were also constructed. One hole (2.0 mm in diameter and 2.0 cm in length) was made in each mold for the insertion of a screw guide. We performed a simulated surgery using the bone model and the mold before operation in all patients. The mold was firmly attached to the surface of the lamina and the guide wire was inserted using the intraoperative image of lateral vertebra. The proper insertion point, direction, and length of the guide were also confirmed both with the model bone and the image intensifier in the operative field. Then, drilling using a cannulated drill and tapping using a cannulated tapping device were carried out. Eleven consecutive patients who underwent posterior spinal fusion surgery using this technique since 2009 are included. The screw positions in the sagittal and axial planes were evaluated by postoperative CT scan to check for malpositioning. The screw insertion was done in the same manner as the simulated surgery. With the aid of this guide the pedicle screws and Magerl screws could be easily inserted even at the level where the pedicle seemed to be very thin and sclerotic on the CT scan. Postoperative CT scan showed that there were no critical breaches of the screws. This method employing the device using a 3-dimensional image guide seems to be easy and safe to use. The technique may improve the safety of pedicle screw and Magerl screw insertion even in difficult cases with narrow sclerotic pedicles.

Biocompatibility testing of NiTi screws using immunohistochemistry on sections containing metallic implants.

PubMed

Berger-Gorbet, M; Broxup, B; Rivard, C; Yahia, L H

1996-10-01

NiTi is one of the most innovative concepts to have appeared in the field of metallic biomaterials in recent years but its biocompatibility remains controversial. We evaluated the biocompatibility of Nitinol screws using immunohistochemistry to observe the distribution of bone proteins during bone remodeling process around NiTi implant. Results were compared with screws made of Vitallium, c.p. titanium, Duplex austenitic-ferritic stainless steel (SAF), and Stainless Steel 316L. Screws were implanted in rabbit tibia for 3, 6, and 12 weeks. Embedding was performed in the hard resin Technovit, and for the immunohistochemical procedure undecalcified sections with bone-anchored implants could thus be used. The immunostaining method developed seemed to be a reliable technique to stain proteins in undecalcified sections. Biocompatibility results of the NiTi screws compared with the other screws showed a slower osteogenesis process characterized by no close contact between implant and bone, disorganized migration of osteoblasts around the implant, and a lower activity of osteonectin synthesis.

Absorbable screws through the greater trochanter do not disturb physeal growth: rabbit experiments.

PubMed

Gil-Albarova, J; Fini, M; Gil-Albarova, R; Melgosa, M; Aldini-Nicolo, N; Giardino, R; Seral, F

1998-06-01

We studied the effect of implantation of self-reinforced polyglycolic acid (SR-PGA) screws through the greater trochanter in rabbits. 15 rabbits aged 10 weeks had an SR-PGA screw inserted through the left trochanter physis. A similar drilling was made through the right greater trochanter without screw implantation. The animals were assigned to 3 groups of 5, and were killed after 1, 2 or 3 months. Radiographs of both femurs were obtained monthly and the articulo-trochanteric distance and the neck-shaft angle were measured. After killing the animals, a histological study was performed. The drilling on the right trochanter generated a bony bridge in all the animals. The SR-PGA screws did not give rise to an epiphysiodesis. The progressive peripheral degradation of the implants gave rise to the formation of only modest bridges, which were smaller in size than those observed in the control trochanter. Our findings suggest that absorbable PGA screws implanted through a growth plate cause only minor bone formation and no epiphyseodesis.

Biomechanical characteristics of bioabsorbable magnesium-based (MgYREZr-alloy) interference screws with different threads.

PubMed

Ezechieli, Marco; Ettinger, Max; König, Carolin; Weizbauer, Andreas; Helmecke, Patrick; Schavan, Robert; Lucas, Arne; Windhagen, Henning; Becher, Christoph

2016-12-01

Degradable magnesium implants have received increasing interest in recent years. In anterior cruciate ligament reconstruction surgery, the well-known osteoconductive effects of biodegradable magnesium alloys may be useful. The aim of this study was to examine whether interference screws made of MgYREZr have comparable biomechanical properties to commonly used biodegradable screws and whether a different thread on the magnesium screw has an influence on the fixation strength. Five magnesium (MgYREZr-alloy) screws were tested per group. Three different groups with variable thread designs (Designs 1, 2, and 3) were produced and compared with the commercially available bioabsorbable Bioacryl rapid polylactic-co-glycolic acid screw Milagro ® . In vitro testing was performed in synthetic bone using artificial ligament fixed by an interference screw. The constructs were pretensioned with a constant load of 60 N for 30 s followed by 500 cycles between 60 N and 250 N at 1 Hz. Construct displacements between the 1st and 20th and the 21st and 500th cycles were recorded. After a 30 s break, a maximum load to failure test was performed at 1 mm/s measuring the maximum pull-out force. The maximum loads to failure of all three types of magnesium interference screws (Design 1: 1,092 ± 133.7 N; Design 2: 1,014 ± 103.3 N; Design 3: 1,001 ± 124 N) were significantly larger than that of the bioabsorbable Milagro ® interference screw (786.8 ± 62.5 N) (p < 0.05). However, the greatest maximum load was found with magnesium screw Design 1. Except for a significant difference between Designs 1 and 2, there were no further significant differences among the four groups in displacement after the 20th cycle. Biomechanical testing showed higher pull-out forces for magnesium compared with a commercial polymer screw. Hence, they suggest better stability and are a potential alternative. The thread geometry does not significantly influence the stability provided by the magnesium implants. This study shows the first promising results of a degradable material, which may be a clinical alternative in the future.

Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study.

PubMed

Wang, Huixiang; Wang, Fang; Leong, Anthony Peng Yew; Xu, Lu; Chen, Xiaojun; Wang, Qiugen

2016-09-01

Augmented reality (AR) enables superimposition of virtual images onto the real world. The aim of this study is to present a novel AR-based navigation system for sacroiliac screw insertion and to evaluate its feasibility and accuracy in cadaveric experiments. Six cadavers with intact pelvises were employed in our study. They were CT scanned and the pelvis and vessels were segmented into 3D models. The ideal trajectory of the sacroiliac screw was planned and represented visually as a cylinder. For the intervention, the head mounted display created a real-time AR environment by superimposing the virtual 3D models onto the surgeon's field of view. The screws were drilled into the pelvis as guided by the trajectory represented by the cylinder. Following the intervention, a repeat CT scan was performed to evaluate the accuracy of the system, by assessing the screw positions and the deviations between the planned trajectories and inserted screws. Post-operative CT images showed that all 12 screws were correctly placed with no perforation. The mean deviation between the planned trajectories and the inserted screws was 2.7 ± 1.2 mm at the bony entry point, 3.7 ± 1.1 mm at the screw tip, and the mean angular deviation between the two trajectories was 2.9° ± 1.1°. The mean deviation at the nerve root tunnels region on the sagittal plane was 3.6 ± 1.0 mm. This study suggests an intuitive approach for guiding screw placement by way of AR-based navigation. This approach was feasible and accurate. It may serve as a valuable tool for assisting percutaneous sacroiliac screw insertion in live surgery.

Validation of an improved method to calculate the orientation and magnitude of pedicle screw bending moments.

PubMed

Freeman, Andrew L; Fahim, Mina S; Bechtold, Joan E

2012-10-01

Previous methods of pedicle screw strain measurement have utilized complex, time consuming methods of strain gauge application, experience high failure rates, do not effectively measure resultant bending moments, and cannot predict moment orientation. The purpose of this biomechanical study was to validate an improved method of quantifying pedicle screw bending moment orientation and magnitude. Pedicle screws were instrumented to measure biplanar screw bending moments by positioning four strain gauges on flat, machined surfaces below the screw head. Screws were calibrated to measure bending moments by hanging certified weights a known distance from the strain gauges. Loads were applied in 30 deg increments at 12 different angles while recording data from two independent strain channels. The data were then analyzed to calculate the predicted orientation and magnitude of the resultant bending moment. Finally, flexibility tests were performed on a cadaveric motion segment implanted with the instrumented screws to demonstrate the implementation of this technique. The difference between the applied and calculated orientation of the bending moments averaged (±standard error of the mean (SEM)) 0.3 ± 0.1 deg across the four screws for all rotations and loading conditions. The calculated resultant bending moments deviated from the actual magnitudes by an average of 0.00 ± 0.00 Nm for all loading conditions. During cadaveric testing, the bending moment orientations were medial/lateral in flexion-extension, variable in lateral bending, and diagonal in axial torsion. The technique developed in this study provides an accurate method of calculating the orientation and magnitude of screw bending moments and can be utilized with any pedicle screw fixation system.

Long-term outcome of cemented versus screw-retained implant-supported partial restorations.

PubMed

Nissan, Joseph; Narobai, Demitri; Gross, Ora; Ghelfan, Oded; Chaushu, Gavriel

2011-01-01

The present study was designed to compare the long-term outcome and complications of cemented versus screw-retained implant restorations in partially edentulous patients. Consecutive patients with bilateral partial posterior edentulism comprised the study group. Implants were placed, and cemented or screw-retained restorations were randomly assigned to the patients in a split-mouth design. Follow-up (up to 15 years) examinations were performed every 6 months in the first year and every 12 months in subsequent years. The following parameters were evaluated and recorded at each recall appointment: ceramic fracture, abutment screw loosening, metal frame fracture, Gingival Index, and marginal bone loss. Thirty-eight patients were treated with 221 implants to support partial prostheses. No implants during the follow-up period (mean follow-up, 66 ± 47 months for screw-retained restorations [range, 18 to 180 months] and 61 ± 40 months for cemented restorations [range, 18 to 159 months]). Ceramic fracture occurred significantly more frequently (P < .001) in screw-retained (38% ± 0.3%) than in cemented (4% ± 0.1%) restorations. Abutment screw loosening occurred statistically significantly more often (P = .001) in screw-retained (32% ± 0.3%) than in cement-retained (9% ± 0.2%) restorations. There were no metal frame fractures in either type of restoration. The mean Gingival Index scores were statistically significantly higher (P < .001) for screw-retained (0.48 ± 0.5) than for cemented (0.09 ± 0.3) restorations. The mean marginal bone loss was statistically significantly higher (P < .001) for screw-retained (1.4 ± 0.6 mm) than for cemented (0.69 ± 0.5 mm) restorations. The long-term outcome of cemented implant-supported restorations was superior to that of screw-retained restorations, both clinically and biologically.

Pullout strength of cancellous screws in human femoral heads depends on applied insertion torque, trabecular bone microarchitecture and areal bone mineral density.

PubMed

Ab-Lazid, Rosidah; Perilli, Egon; Ryan, Melissa K; Costi, John J; Reynolds, Karen J

2014-12-01

For cancellous bone screws, the respective roles of the applied insertion torque (TInsert) and of the quality of the host bone (microarchitecture, areal bone mineral density (aBMD)), in contributing to the mechanical holding strength of the bone-screw construct (FPullout), are still unclear. During orthopaedic surgery screws are tightened, typically manually, until adequate compression is attained, depending on surgeons' manual feel. This corresponds to a subjective insertion torque control, and can lead to variable levels of tightening, including screw stripping. The aim of this study, performed on cancellous screws inserted in human femoral heads, was to investigate which, among the measurements of aBMD, bone microarchitecture, and the applied TInsert, has the strongest correlation with FPullout. Forty six femoral heads were obtained, over which microarchitecture and aBMD were evaluated using micro-computed tomography and dual X-ray absorptiometry. Using an automated micro-mechanical test device, a cancellous screw was inserted in the femoral heads at TInsert set to 55% to 99% of the predicted stripping torque beyond screw head contact, after which FPullout was measured. FPullout exhibited strongest correlations with TInsert (R=0.88, p<0.001), followed by structure model index (SMI, R=-0.81, p<0.001), bone volume fraction (BV/TV, R=0.73, p<0.001) and aBMD (R=0.66, p<0.01). Combinations of TInsert with microarchitectural parameters and/or aBMD did not improve the prediction of FPullout. These results indicate that, for cancellous screws, FPullout depends most strongly on the applied TInsert, followed by microarchitecture and aBMD of the host bone. In trabecular bone, screw tightening increases the holding strength of the screw-bone construct. Copyright © 2014 Elsevier Ltd. All rights reserved.

Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia.

PubMed

Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

2013-01-01

For the past decade, a screw-rod construct has been used commonly to stabilize the atlantoaxial joint, but the insertion of the screw through the C1 lateral mass (LM) can cause several complications. We evaluated whether using a higher screw entry point for C1 lateral mass (LM) fixation than in the standard procedure could prevent screw-induced occipital neuralgia. We enrolled 12 consecutive patients who underwent bilateral C1 LM fixation, with the modified screw insertion point at the junction of the C1 posterior arch and the midpoint of the posterior inferior portion of the C1 LM. We measured postoperative clinical and radiological parameters and recorded intraoperative complications, postoperative neurological deficits and the occurrence of occipital neuralgia. Postoperative plain radiographs were used to check for malpositioning of the screw or failure of the construct. Four patients underwent atlantoaxial stabilization for a transverse ligament injury or a C1 or C2 fracture, six patients for os odontoideum, and two patients for C2 metastasis. No patient experienced vertebral artery injury or cerebrospinal fluid leak, and all had minimal blood loss. No patient suffered significant occipital neuralgia, although one patient developed mild, transient unilateral neuralgia. There was also no radiographic evidence of construct failure. Twenty screws were positioned correctly through the intended entry points, but three screws were placed inferiorly (that is, below the arch), and one screw was inserted too medially. When performing C1-C2 fixation using the standard (Harms) construct, surgeons should be aware of the possible development of occipital neuralgia. A higher entry point may prevent this complication; therefore, we recommend that the screw should be inserted into the arch of C1 if it can be accommodated. Copyright © 2012 Elsevier Ltd. All rights reserved.

Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty.

PubMed

Yoon, Sun-Jung; Park, Myung-Sik; Matsuda, Dean K; Choi, Yun Ho

2018-06-04

Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty.

Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band.

PubMed

Wagener, Marc L; Dezillie, Marleen; Hoendervangers, Yvette; Eygendaal, Denise

2015-04-01

Exposure of the distal humerus in case of an articular fracture is often performed through a Chevron osteotomy of the olecranon. Several options have been described for re-fixation of the Chevron osteotomy. Pull-out of the hard-wear is often seen as complication. In this study, an evaluation of the re-fixation of the Chevron osteotomy through a cancellous screw and suture tension band was performed. The data of 19 patients in whom a Chevron osteotomy was re-fixated with a cancellous screw in combination with a suture tension band were used. Evaluation was performed by assessment of the post-operative X-rays and documentation of complications. In all 19 cases, evaluation of the post-operative X-rays showed complete consolidation without dislocation or other complications. Re-fixation of a Chevron osteotomy of the olecranon with a large cancellous screw with a suture tension band provides adequate stability to result in proper healing of the osteotomy in primary cases when early post-operative mobilisation is allowed. Complications as pull-out of the hard-wear were not reported.

Factors influencing interlocking screw failure in unreamed small diameter nails--a biomechanical study using a distal tibia fracture model.

PubMed

Weninger, Patrick; Schueller, Michael; Jamek, Michael; Stanzl-Tschegg, Stefanie; Redl, Heinz; Tschegg, Elmar K

2009-05-01

Unreamed tibia nails with small diameters are increasingly used for fracture fixation. However, little is known about the fatigue strength of proximal and distal interlocking screws in those nails. To date, no data are available reporting on mechanical differences of solid compared to cannulated tibial nails. The aim of this study was to assess the fatigue strength of proximal and distal interlocking screws of solid and cannulated small diameter tibia nails. We created a distal tibia fracture model (AO/OTA 43 A3) using 16 Sawbones. After fracture stabilization with one of four different nail types (Expert Tibial Nail, VersaNail, T2 Tibial Nailing System, Connex), mechanical testing was performed in three loading series (40,000 cycles each) with incremental loads. Timing and type of interlocking screw failure were assessed. Interlocking screw failure was observed significantly earlier (after a mean interval of 57,042 cycles) in cannulated tibial nails (VersaNail, T2) compared to solid nails (after a mean interval of 88,415 cycles; P < 0.001). Proximal interlocking screw failure was recorded if oblique screws were used proximally (VersaNail, T2, Connex). No distal interlocking screw failure was recorded in the Connex nail. Two- and three-part fractures of proximal or distal interlocking screws were observed in all specimen. Proximal and distal interlocking screw failure has to be considered in small diameter nails in case of delayed fracture healing. To support our results, further experimental studies and clinical series are necessary.

Morphometric Evaluation of Occipital Condyles: Defining Optimal Trajectories and Safe Screw Lengths for Occipital Condyle-Based Occipitocervical Fixation in Indian Population.

PubMed

Bosco, Aju; Venugopal, Prakash; Shetty, Ajoy Prasad; Shanmuganathan, Rajasekaran; Kanna, Rishi Mugesh

2018-04-01

Computed tomographic (CT) morphometric analysis. To assess the feasibility and safety of occipital condyle (OC)-based occipitocervical fixation (OCF) in Indians and to define anatomical zones and screw lengths for safe screw placement. Limitations of occipital squama-based OCF has led to development of two novel OC-based OCF techniques. Morphometric analysis was performed on the OCs of 70 Indian adults. The feasibility of placing a 3.5-mm-diameter screw into OCs was investigated. Safe trajectories and screw lengths for OC screws and C0-C1 transarticular screws without hypoglossal canal or atlantooccipital joint compromise were estimated. The average screw length and safe sagittal and medial angulations for OC screws were 19.9±2.3 mm, ≤6.4°±2.4° cranially, and 31.1°±3° medially, respectively. An OC screw could not be accommodated by 27% of the population. The safe sagittal angles and screw lengths for C0-C1 transarticular screw insertion (48.9°±5.7° cranial, 26.7±2.9 mm for junctional entry technique; 36.7°±4.6° cranial, 31.6±2.7 mm for caudal C1 arch entry technique, respectively) were significantly different than those in other populations. The risk of vertebral artery injury was high for the caudal C1 arch entry technique. Screw placement was uncertain in 48% of Indians due to the presence of aberrant anatomy. There were significant differences in the metrics of OC-based OCF between Indian and other populations. Because of the smaller occipital squama dimensions in Indians, OC-based OCF techniques may have a higher application rate and could be a viable alternative/salvage option in selected cases. Preoperative CT, including three-dimensional-CT-angiography (to delineate vertebral artery course), is imperative to avoid complications resulting from aberrant bony and vascular anatomy. Our data can serve as a valuable reference guide in placing these screws safely under fluoroscopic guidance.

Morphometric Evaluation of Occipital Condyles: Defining Optimal Trajectories and Safe Screw Lengths for Occipital Condyle-Based Occipitocervical Fixation in Indian Population

PubMed Central

Bosco, Aju; Venugopal, Prakash; Shanmuganathan, Rajasekaran; Kanna, Rishi Mugesh

2018-01-01

Study Design Computed tomographic (CT) morphometric analysis. Purpose To assess the feasibility and safety of occipital condyle (OC)-based occipitocervical fixation (OCF) in Indians and to define anatomical zones and screw lengths for safe screw placement. Overview of Literature Limitations of occipital squama-based OCF has led to development of two novel OC-based OCF techniques. Methods Morphometric analysis was performed on the OCs of 70 Indian adults. The feasibility of placing a 3.5-mm-diameter screw into OCs was investigated. Safe trajectories and screw lengths for OC screws and C0–C1 transarticular screws without hypoglossal canal or atlantooccipital joint compromise were estimated. Results The average screw length and safe sagittal and medial angulations for OC screws were 19.9±2.3 mm, ≤6.4°±2.4° cranially, and 31.1°±3° medially, respectively. An OC screw could not be accommodated by 27% of the population. The safe sagittal angles and screw lengths for C0–C1 transarticular screw insertion (48.9°±5.7° cranial, 26.7±2.9 mm for junctional entry technique; 36.7°±4.6° cranial, 31.6±2.7 mm for caudal C1 arch entry technique, respectively) were significantly different than those in other populations. The risk of vertebral artery injury was high for the caudal C1 arch entry technique. Screw placement was uncertain in 48% of Indians due to the presence of aberrant anatomy. Conclusions There were significant differences in the metrics of OC-based OCF between Indian and other populations. Because of the smaller occipital squama dimensions in Indians, OC-based OCF techniques may have a higher application rate and could be a viable alternative/salvage option in selected cases. Preoperative CT, including three-dimensional-CT-angiography (to delineate vertebral artery course), is imperative to avoid complications resulting from aberrant bony and vascular anatomy. Our data can serve as a valuable reference guide in placing these screws safely under fluoroscopic guidance. PMID:29713401

LWH and ACH Helmet Hardware Study

DTIC Science & Technology

2015-11-30

initial attempts to perform impact tests using screws mounted in Kevlar composite panels resulted in little damage to the screws, but a lot of...stiffer and stronger than Kevlar panels, does not plastically deform (and therefore Figure 11. Typical ductile fracture surface resulting from a

The infrared camera application for calculating the impact of the feed screw thermal expansion on machining accuracy

NASA Astrophysics Data System (ADS)

Matras, A.

2017-08-01

The paper discusses the impact of the feed screw heating on the machining accuracy. The test stand was built based on HASS Mini Mill 2 CNC milling machine and a Flir SC620 infrared camera. Measurements of workpiece were performed on Talysurf Intra 50 Taylor Hobson profilometer. The research proved that the intensive work of the milling machine lasted 60 minutes, causing thermal expansion of the feed screw what influence on the dimension error of the workpiece.

Molar uprighting with mini screws: comparison among different systems and relative biomechanical analysis.

PubMed

Musilli, Marino; Marsico, Marco; Romanucci, Annalisa; Grampone, Francesco

2010-01-01

Starting from a segmented approach, the Authors propose 3 different methods of using mini screws during the process of molar uprighting. The first UPG is performed by placing a mini screw in the retromolar area and by applying an elastic chain loaded between the screw and the molar.The second UPG is made by placing a screw in the retro molar area and by using a small cantilever which is active during intrusion and uprighting.The third UPG is made by using a miniscrew placed a few millimeters mesial to the molar to control the vertical force produced by the uprighting with a long cantilever to the frontal teeth.To assist in the understanding of the different clinical indications, the biomechanical differences between these three systems are analyzed. Copyright © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.

EFFECT OF PILOT HOLE TAPPING ON PULLOUT STRENGTH AND INSERTION TORQUE OF DUAL CORE PEDICLE SCREWS.

PubMed

Rosa, Rodrigo César; Silva, Patrícia; Falcai, Maurício José; Shimano, Antônio Carlos; Defino, Helton Luiz Aparecido

2010-01-01

To evaluate the influence of pilot hole tapping on pullout resistance and insertion torque of pedicle screws with a conical core. Mechanical tests using a universal testing machine were performed on pedicle screws with a conical core that were inserted into pedicles in the fifth lumbar vertebra of calves. The insertion torque was measured using a torque meter with a capacity of 10 Nm, which was considered to be the highest torque value. The pilot holes were prepared using a probe of external diameter 3.8 mm and tapping of the same dimensions and thread characteristics as the screw. Decreased insertion torque and pullout resistance were observed in the group with prior tapping of the pilot hole. Pilot hole tapping reduced the insertion torque and pullout resistance of pedicle screws with a conical core that had been inserted into the pedicle of the fifth lumbar vertebra of calves.

Neurovascular risks of sacral screws with bicortical purchase: an anatomical study.

PubMed

Ergur, Ipek; Akcali, Omer; Kiray, Amac; Kosay, Can; Tayefi, Hamid

2007-09-01

The aim of this cadaver study is to define the anatomic structures on anterior sacrum, which are under the risk of injury during bicortical screw application to the S1 and S2 pedicles. Thirty formaldehyde-preserved human male cadavers were studied. Posterior midline incision was performed, and soft tissues and muscles were dissected from the posterior part of the lumbosacral region. A 6 mm pedicle screw was inserted between the superior facet of S1 and the S1 foramen. The entry point of the S2 pedicle screw was located between S1 and S2 foramina. S1 and S2 screws were placed on both right and the left sides of all cadavers. Then, all cadavers were turned into supine position. All abdominal and pelvic organs were moved away and carefully observed for any injury. The tips of the sacral screws were marked and the relations with the anatomic structures were defined. The position of the sacral screws relative to the middle and lateral sacral arteries and veins, and the sacral sympathetic trunk were measured. There was no injury to the visceral organs. In four cases, S1 screw tip was in direct contact with middle sacral artery. In two cases, S1 screw tip was in direct contact with middle sacral vein. It was observed that the S1 screw tips were in close proximity to sacral sympathetic trunk on both right and the left sides. The tip of the S2 screw was in contact with middle sacral artery on the left side only in one case. It is found that the tip of the S2 screw was closely located with the middle sacral vein in two cases. The tip of the S2 pedicle screw was in contact with the sacral sympathetic trunk in eight cases on the right side and seven cases on the left side. Lateral sacral vein was also observed to be disturbed by the S1 and S2 screws. As a conclusion, anterior cortical penetration during sacral screw insertion carries a risk of neurovascular injury. The risk of sacral sympathetic trunk and minor vascular structures together with the major neurovascular structures and viscera should be kept in mind.

Economics of water injected air screw compressor systems

NASA Astrophysics Data System (ADS)

Venu Madhav, K.; Kovačević, A.

2015-08-01

There is a growing need for compressed air free of entrained oil to be used in industry. In many cases it can be supplied by oil flooded screw compressors with multi stage filtration systems, or by oil free screw compressors. However, if water injected screw compressors can be made to operate reliably, they could be more efficient and therefore cheaper to operate. Unfortunately, to date, such machines have proved to be insufficiently reliable and not cost effective. This paper describes an investigation carried out to determine the current limitations of water injected screw compressor systems and how these could be overcome in the 15-315 kW power range and delivery pressures of 6-10 bar. Modern rotor profiles and approach to sealing and cooling allow reasonably inexpensive air end design. The prototype of the water injected screw compressor air system was built and tested for performance and reliability. The water injected compressor system was compared with the oil injected and oil free compressor systems of the equivalent size including the economic analysis based on the lifecycle costs. Based on the obtained results, it was concluded that water injected screw compressor systems could be designed to deliver clean air free of oil contamination with a better user value proposition than the oil injected or oil free screw compressor systems over the considered range of operations.

Tapping insertional torque allows prediction for better pedicle screw fixation and optimal screw size selection.

PubMed

Helgeson, Melvin D; Kang, Daniel G; Lehman, Ronald A; Dmitriev, Anton E; Luhmann, Scott J

2013-08-01

There is currently no reliable technique for intraoperative assessment of pedicle screw fixation strength and optimal screw size. Several studies have evaluated pedicle screw insertional torque (IT) and its direct correlation with pullout strength. However, there is limited clinical application with pedicle screw IT as it must be measured during screw placement and rarely causes the spine surgeon to change screw size. To date, no study has evaluated tapping IT, which precedes screw insertion, and its ability to predict pedicle screw pullout strength. The objective of this study was to investigate tapping IT and its ability to predict pedicle screw pullout strength and optimal screw size. In vitro human cadaveric biomechanical analysis. Twenty fresh-frozen human cadaveric thoracic vertebral levels were prepared and dual-energy radiographic absorptiometry scanned for bone mineral density (BMD). All specimens were osteoporotic with a mean BMD of 0.60 ± 0.07 g/cm(2). Five specimens (n=10) were used to perform a pilot study, as there were no previously established values for optimal tapping IT. Each pedicle during the pilot study was measured using a digital caliper as well as computed tomography measurements, and the optimal screw size was determined to be equal to or the first size smaller than the pedicle diameter. The optimal tap size was then selected as the tap diameter 1 mm smaller than the optimal screw size. During optimal tap size insertion, all peak tapping IT values were found to be between 2 in-lbs and 3 in-lbs. Therefore, the threshold tapping IT value for optimal pedicle screw and tap size was determined to be 2.5 in-lbs, and a comparison tapping IT value of 1.5 in-lbs was selected. Next, 15 test specimens (n=30) were measured with digital calipers, probed, tapped, and instrumented using a paired comparison between the two threshold tapping IT values (Group 1: 1.5 in-lbs; Group 2: 2.5 in-lbs), randomly assigned to the left or right pedicle on each specimen. Each pedicle was incrementally tapped to increasing size (3.75, 4.00, 4.50, and 5.50 mm) until the threshold value was reached based on the assigned group. Pedicle screw size was determined by adding 1 mm to the tap size that crossed the threshold torque value. Torque measurements were recorded with each revolution during tap and pedicle screw insertion. Each specimen was then individually potted and pedicle screws pulled out "in-line" with the screw axis at a rate of 0.25 mm/sec. Peak pullout strength (POS) was measured in Newtons (N). The peak tapping IT was significantly increased (50%) in Group 2 (3.23 ± 0.65 in-lbs) compared with Group 1 (2.15 ± 0.56 in-lbs) (p=.0005). The peak screw IT was also significantly increased (19%) in Group 2 (8.99 ± 2.27 in-lbs) compared with Group 1 (7.52 ± 2.96 in-lbs) (p=.02). The pedicle screw pullout strength was also significantly increased (23%) in Group 2 (877.9 ± 235.2 N) compared with Group 1 (712.3 ± 223.1 N) (p=.017). The mean pedicle screw diameter was significantly increased in Group 2 (5.70 ± 1.05 mm) compared with Group 1 (5.00 ± 0.80 mm) (p=.0002). There was also an increased rate of optimal pedicle screw size selection in Group 2 with 9 of 15 (60%) pedicle screws compared with Group 1 with 4 of 15 (26.7%) pedicle screws within 1 mm of the measured pedicle width. There was a moderate correlation for tapping IT with both screw IT (r=0.54; p=.002) and pedicle screw POS (r=0.55; p=.002). Our findings suggest that tapping IT directly correlates with pedicle screw IT, pedicle screw pullout strength, and optimal pedicle screw size. Therefore, tapping IT may be used during thoracic pedicle screw instrumentation as an adjunct to preoperative imaging and clinical experience to maximize fixation strength and optimize pedicle "fit and fill" with the largest screw possible. However, further prospective, in vivo studies are necessary to evaluate the intraoperative use of tapping IT to predict screw loosening/complications. Published by Elsevier Inc.

A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine.

PubMed

Merc, Matjaz; Drstvensek, Igor; Vogrin, Matjaz; Brajlih, Tomaz; Recnik, Gregor

2013-07-01

The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups. The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group. The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.

Non-Micropipe Dislocations in 4H-SiC Devices: Electrical Properties and Device Technology Implications

NASA Technical Reports Server (NTRS)

Neudeck, Philip G.; Huang, Wei; Dudley, Michael; Fazi, Christian

1998-01-01

It is well-known that SiC wafer quality deficiencies are delaying the realization of outstandingly superior 4H-SiC power electronics. While efforts to date have centered on eradicating micropipes (i.e., hollow core super-screw dislocations with Burgers vectors greater than or equal to 2c), 4H-SiC wafers and epilayers also contain elementary screw dislocations (i.e., Burgers vector = 1c with no hollow core) in densities on the order of thousands per sq cm, nearly 100-fold micropipe densities. While not nearly as detrimental to SiC device performance as micropipes, it has recently been demonstrated that elementary screw dislocations somewhat degrade the reverse leakage and breakdown properties of 4H-SiC p(+)n diodes. Diodes containing elementary screw dislocations exhibited a 5% to 35% reduction in breakdown voltage, higher pre-breakdown reverse leakage current, softer reverse breakdown I-V knee, and microplasmic breakdown current filaments that were non-catastrophic as measured under high series resistance biasing. This paper details continuing experimental and theoretical investigations into the electrical properties of 4H-SiC elementary screw dislocations. The nonuniform breakdown behavior of 4H-SiC p'n junctions containing elementary screw dislocations exhibits interesting physical parallels with nonuniform breakdown phenomena previously observed in other semiconductor materials. Based upon experimentally observed dislocation-assisted breakdown, a re-assessment of well-known physical models relating power device reliability to junction breakdown has been undertaken for 4H-SiC. The potential impact of these elementary screw dislocation defects on the performance and reliability of various 4H-SiC device technologies being developed for high-power applications will be discussed.

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study.

PubMed

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-11-01

A cadaveric laboratory study. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. N/A.

Leakage effect analysis on the performance of a cylindrical adjustable inertance tube

NASA Astrophysics Data System (ADS)

Zhou, Wenjie; Pfotenhauer, John M.; Zhi, Xiaoqin

2018-04-01

The inertance tube plays a significant role in improving the performance of the Stirling type pulse tube cryocooler by providing the desired phase angle between the mass flow and pressure wave. The phase angle is highly depended on the inertance tube geometry, such as diameter and length. A cylindrical threaded root device with variable thread depth on the outer screw and inner screw creates an adjustable inertance tube whose diameter and length can be adjusted in the real time. However, due to its geometry imperfectness, the performance of this threaded inertance tube is reduced by the leaks through the roots between the two screws. Its phase angle shift ability is decreased by 30% with the leakage clearance thickness of 15.5 μm according to both the theoretical prediction and the experimental verification.

A pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components - a cadaveric study.

PubMed

Möbius, R; Schleifenbaum, S; Grunert, R; Löffler, S; Werner, M; Prietzel, T; Hammer, N

2016-10-01

The removal of well-fixed acetabular components following THA (total hip arthroplasty) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups. Tear-out resistance and related mechanical work required for the tear-out of osseo-integrated screw sockets are higher than in non-integrated screw sockets. Ten human coxal bones from six cadavers with osseo-integrated screw sockets (n=4), non-integrated (implanted post-mortem, n=3) screw sockets and cemented polyethylene cups (n=3) were used for tear-out testing. The parameters axial failure load and mechanical work for tear-out were introduced as measures for determining the stability of acetabular components following THA. The osseo-integrated screw sockets yielded slightly higher tear-out resistance (1.61±0.26kN) and related mechanical work compared to the non-integrated screw sockets (1.23±0.39kN, P=0.4). The cemented polyethylene cups yielded the lowest tear-out resistance with a failure load of 1.18±0.24kN. Compared to the screw cups implanted while alive, they also differ on a non-significant level (P=0.1). Osseous failure patterns differed especially for the screw sockets compared to the cemented polyethylene cups. Osseo-integration did not greatly influence the tear-out stability in cementless screw sockets following axial loading. Furthermore, the strength of the bone-implant-interface of cementless screw sockets appears to be similar to cemented polyethylene cups. However, given the high failure load, high mechanical load and because of the related bone failure patterns, removal should not be performed by means of tear-out but rather by osteotomes or other curved cutting devices to preserve the acetabular bone stock. Level III, case-control-study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Salmon Supplementation Studies in Idaho Rivers, 1996-1998 Progress Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reighn, Christopher A.; Lewis, Bert; Taki, Doug

1999-06-01

Information contained in this report summarizes the work that has been done by the Shoshone-Bannock Tribes Fisheries Department under BPA Project No. 89-098-3, Contract Number 92-BI-49450. Relevant data generated by the Shoshone-Bannock Tribe will be collated with other ISS cooperator data collected from the Salmon and Clearwater rivers and tributary streams. A summary of data presented in this report and an initial project-wide level supplementation evaluation will be available in the ISS 5 year report that is currently in progress. The Shoshone-Bannock Tribal Fisheries Department is responsible for monitoring a variety of chinook salmon (Oncorhynchus tshawytscha) production parameters as partmore » of the Idaho Supplementation Studies (BPA Project No. 89-098-3, Contract Number 92-BI-49450). Parameters include parr abundance in tributaries to the upper Salmon River; adult chinook salmon spawner abundance, redd counts, and carcass collection. A rotary screw trap is operated on the East Fork Salmon River and West Fork Yankee Fork Salmon River to enumerate and PIT-tag chinook smolts. These traps are also used to monitor parr movement, and collect individuals for the State and Tribal chinook salmon captive rearing program. The SBT monitors fisheries parameters in the following six tributaries of the Salmon River: Bear Valley Creek, East Fork Salmon River, Herd Creek, South Fork Salmon River, Valley Creek, and West Fork Yankee Fork. Chinook populations in all SBT-ISS monitored streams continue to decline. The South Fork Salmon River and Bear Valley Creek have the strongest remaining populations. Snorkel survey methodology was used to obtain parr population estimates for ISS streams from 1992 to 1997. Confidence intervals for the parr population estimates were large, especially when the populations were low. In 1998, based on ISS cooperator agreement, snorkeling to obtain parr population estimates was ceased due to the large confidence intervals. A rotary screw trap was operated on the West Fork Yankee Fork during the spring, summer, and fall of 1998 to monitor juvenile chinook migration. A screw trap was also operated on the East Fork of the Salmon River during the spring and fall from 1993 to 1997. Supplementation treatments have occurred on the South Fork Salmon River (IDFG), the East Fork Salmon River (EFSR), and the West Fork Yankee Fork of the Salmon River (WFYF). The EFSR received supplementation treatments yearly through 1995. There have been no treatments since 1995, and no significant future treatments from local broodstock are planned due to extremely poor escapement. The WFYF received a single presmolt treatment in 1994. There was an egg and adult release treatment in 1998 from the captive rearing program, not part of the original ISS study. Similarly, no significant future treatments are planned for the West Fork Yankee Fork due to extremely poor escapement. However, small scale experimental captive rearing and broodstock techniques are currently being tested with populations from the EFSR and WFYF. Captive rearing/broodstock techniques could potentially provide feedback for evaluation of supplementation. The other three SBT-ISS streams are control streams and do not receive supplementation treatments.« less

Evaluation of different screw fixation techniques and screw diameters in sagittal split ramus osteotomy: finite element analysis method.

PubMed

Sindel, A; Demiralp, S; Colok, G

2014-09-01

Sagittal split ramus osteotomy (SSRO) is used for correction of numerous congenital or acquired deformities in facial region. Several techniques have been developed and used to maintain fixation and stabilisation following SSRO application. In this study, the effects of the insertion formations of the bicortical different sized screws to the stresses generated by forces were studied. Three-dimensional finite elements analysis (FEA) and static linear analysis methods were used to investigate difference which would occur in terms of forces effecting onto the screws and transmitted to bone between different application areas. No significant difference was found between 1·5- and 2-mm screws used in SSRO fixation. Besides, it was found that 'inverted L' application was more successful compared to the others and that was followed by 'L' and 'linear' formations which showed close rates to each other. Few studies have investigated the effect of thickness and application areas of bicortical screws. This study was performed on both advanced and regressed jaws positions. © 2014 John Wiley & Sons Ltd.

Non-symmetric approach to single-screw expander and compressor modeling

NASA Astrophysics Data System (ADS)

Ziviani, Davide; Groll, Eckhard A.; Braun, James E.; Horton, W. Travis; De Paepe, M.; van den Broek, M.

2017-08-01

Single-screw type volumetric machines are employed both as compressors in refrigeration systems and, more recently, as expanders in organic Rankine cycle (ORC) applications. The single-screw machine is characterized by having a central grooved rotor and two mating toothed starwheels that isolate the working chambers. One of the main features of such machine is related to the simultaneous occurrence of the compression or expansion processes on both sides of the main rotor which results in a more balanced loading on the main shaft bearings with respect to twin-screw machines. However, the meshing between starwheels and main rotor is a critical aspect as it heavily affects the volumetric performance of the machine. To allow flow interactions between the two sides of the rotor, a non-symmetric modelling approach has been established to obtain a more comprehensive model of the single-screw machine. The resulting mechanistic model includes in-chamber governing equations, leakage flow models, heat transfer mechanisms, viscous and mechanical losses. Forces and moments balances are used to estimate the loads on the main shaft bearings as well as on the starwheel bearings. An 11 kWe single-screw expander (SSE) adapted from an air compressor operating with R245fa as working fluid is used to validate the model. A total of 60 steady-steady points at four different rotational speeds have been collected to characterize the performance of the machine. The maximum electrical power output and overall isentropic efficiency measured were 7.31 kW and 51.91%, respectively.

Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits.

PubMed

Diekmann, Julia; Bauer, Sylvie; Weizbauer, Andreas; Willbold, Elmar; Windhagen, Henning; Helmecke, Patrick; Lucas, Arne; Reifenrath, Janin; Nolte, Ingo; Ezechieli, Marco

2016-02-01

The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, μCT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The μCT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials. Copyright © 2015 Elsevier B.V. All rights reserved.

Biomechanical evaluation of a new MatrixMandible plating system on cadaver mandibles.

PubMed

Gateno, Jaime; Cookston, Christopher; Hsu, Sam Sheng-Pin; Stal, Drew N; Durrani, Salim K; Gold, Jonathan; Ismaily, Sabir; Alexander, Jerry W; Noble, Philip C; Xia, James J

2013-11-01

Current mandibular plating systems contain a wide range of plates and screws needed for the treatment of mandibular reconstruction and mandibular fractures. The authors' hypothesis was that a single diameter screw could be used in all applications in a plating system. Therefore, the purpose of this study was to test if the 2.0-mm locking screws could replace the 2.4-mm screws to stabilize a 2.5-mm-thick reconstruction plate in the treatment of mandibular discontinuity. Thirty-six fresh human cadaveric mandibles were used: 18 were plated using 2.0-mm locking screws (experimental) and the other 18 were plated using 2.4-mm locking screws (control). Each group was further divided into 3 subgroups based on the site of loading application: the ipsilateral (right) second premolar region, the central incisal region, and the contralateral (left) first molar region. The same ipsilateral (right) mandibular angular discontinuity was created by the same surgeon. The mandible was mounted on a material testing machine. The micromotions between the 2 segments, permanent and elastic displacements, were recorded after incremental ramping loads. The magnitude of screw back-out and the separation between plate and bone were recorded using a laser scanner (resolution, 0.12 mm) before and after the loading applications. The data were processed. Descriptive analyses and a general linear model for repeated measures analysis of variance were performed. There was no statistically significant difference in permanent displacement (mean, 1.16 and 0.82 mm, respectively) between the 2.0-mm and 2.4-mm screw groups. There also was no statistically significant difference in elastic displacement between the 2 groups (mean, 1.48 and 1.21 mm, respectively). Finally, there were no statistically significant differences in screw back-out or separation between plate and bone between the 2 groups. All means for screw back-out and separation between screw and bone for each group were judged within the error of the laser scanning system (<0.12 mm). One may anticipate that the mechanical functions of the 2.0-mm locking screws are not different from those of the 2.4-mm screws when a 2.5-mm-thick reconstruction plate is used to reconstruct mandibular angular discontinuity. However, further biomechanical studies (ie, fatigue of screws) are warranted before a randomized clinical trial can be conducted to definitively prove that the 2.4-mm screws can be replaced by 2.0-mm screws. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of screw configuration on the particle size distribution of granules produced by twin screw granulation.

PubMed

Vercruysse, J; Burggraeve, A; Fonteyne, M; Cappuyns, P; Delaet, U; Van Assche, I; De Beer, T; Remon, J P; Vervaet, C

2015-02-01

Twin screw granulation (TSG) has been reported by different research groups as an attractive technology for continuous wet granulation. However, in contrast to fluidized bed granulation, granules produced via this technique typically have a wide and multimodal particle size distribution (PSD), resulting in suboptimal flow properties. The aim of the current study was to evaluate the impact of granulator screw configuration on the PSD of granules produced by TSG. Experiments were performed using a 25 mm co-rotating twin screw granulator, being part of the ConsiGma™-25 system (a fully continuous from-powder-to-tablet manufacturing line from GEA Pharma Systems). Besides the screw elements conventionally used for TSG (conveying and kneading elements), alternative designs of screw elements (tooth-mixing-elements (TME), screw mixing elements (SME) and cutters) were investigated using an α-lactose monohydrate formulation granulated with distilled water. Granulation with only conveying elements resulted in wide and multimodal PSD. Using kneading elements, the width of the PSD could be partially narrowed and the liquid distribution was more homogeneous. However, still a significant fraction of oversized agglomerates was obtained. Implementing additional kneading elements or cutters in the final section of the screw configuration was not beneficial. Furthermore, granulation with only TME or SME had limited impact on the width of the PSD. Promising results were obtained by combining kneading elements with SME, as for these configurations the PSD was narrower and shifted to the size fractions suitable for tableting. Copyright © 2015 Elsevier B.V. All rights reserved.

Biomechanical Comparison of 3 Inferiorly Directed Versus 3 Superiorly Directed Locking Screws on Stability in a 3-Part Proximal Humerus Fracture Model.

PubMed

Donohue, David M; Santoni, Brandon G; Stoops, T Kyle; Tanner, Gregory; Diaz, Miguel A; Mighell, Mark

2018-06-01

To quantify the stability of 3 points of inferiorly directed versus 3 points of superiorly directed locking screw fixation compared with the full contingent of 6 points of locked screw fixation in the treatment of a 3-part proximal humerus fracture. A standardized 3-part fracture was created in 10 matched pairs (experimental groups) and 10 nonmatched humeri (control group). Osteosynthesis was performed using 3 locking screws in the superior hemisphere of the humeral head (suspension), 3 locking screws in the inferior hemisphere (buttress), or the full complement of 6 locking screws (control). Specimens were tested in varus cantilever bending (7.5 Nm) to 10,000 cycles or failure. Construct survival (%) and the cycles to failure were compared. Seven of 10 controls survived the 10,000-cycle runout (70%: 8193 average cycles to failure). No experimental constructs survived the 10,000-cycle runout. Suspension and buttress screw groups failed an average of 331 and 516 cycles, respectively (P = 1.00). The average number of cycles to failure and the number of humeri surviving the 10,000-cycle runout were greater in the control group than in the experimental groups (P ≤ 0.006). Data support the use of a full contingent of 6 points of locking screw fixation over 3 superior or 3 inferior points of fixation in the treatment of a 3-part proximal humerus fracture with a locking construct. No biomechanical advantage to the 3 buttress or 3 suspension screws used in isolation was observed.

Comparison of Multidetector Computed Tomography and Flat-Panel Computed Tomography Regarding Visualization of Cortical Fractures, Cortical Defects, and Orthopedic Screws: A Phantom Study.

PubMed

Neubauer, Jakob; Benndorf, Matthias; Lang, Hannah; Lampert, Florian; Kemna, Lars; Konstantinidis, Lukas; Neubauer, Claudia; Reising, Kilian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Goerke, Sebastian M

2015-08-01

To compare the visualization of cortical fractures, cortical defects, and orthopedic screws in a dedicated extremity flat-panel computed tomography (FPCT) scanner and a multidetector computed tomography (MDCT) scanner.We used feet of European roe deer as phantoms for cortical fractures, cortical defects, and implanted orthopedic screws. FPCT and MDCT scans were performed with equivalent dose settings. Six observers rated the scans according to number of fragments, size of defects, size of defects opposite orthopedic screws, and the length of different screws. The image quality regarding depiction of the cortical bone was assessed. The gold standard (real number of fragments) was evaluated by autopsy.The correlation of reader assessment of fragments, cortical defects, and screws with the gold standard was similar for FPCT and MDCT. Three readers rated the subjective image quality of the MDCT to be higher, whereas the others showed no preferences.Although the image quality was rated higher in the MDCT than in the FPCT by 3 out of 6 observers, both modalities proved to be comparable regarding the visualization of cortical fractures, cortical defects, and orthopedic screws and of use to musculoskeletal radiology regarding fracture detection and postsurgical evaluation in our experimental setting.

Removal torque of zirconia abutment screws under dry and wet conditions.

PubMed

Nigro, Frederico; Sendyk, Claudio L; Francischone, Carlos Eduardo; Francischone, Carlos Eduardo

2010-01-01

The aim of this study was to verify whether screw abutment lubrication can generate higher preload values compared to non-lubricated screws, a titanium abutment was screwed onto an implant analog and scanned with the Procera System to generate 20 zirconia abutments. MKIII Brånemark implants were clamped to a precision torque device, and the abutments were distributed in dry and wet groups with 10 specimens each. In the wet groups, the inner threads of the implants were filled with artificial saliva. All abutments were fastened with a Torqtite screw under 32 Ncm. Ten detorque measurements were performed per group pushing the reverse button of the Torque controller soon after screw tightening with values registered. The mean detorque values were calculated and compared by a Student's t test (α=0.05). The wet condition presented significantly higher mean detorque than the dry condition (31.5 ± 1.2 versus 27.5 ± 1.5 Ncm, respectively; p=0.0000024). In conclusion, there was always a loss in the initial torque values when the removal torque was measured under both conditions. The wet condition presented higher mean torque than the dry condition. Better preload values were established in the wet group, suggesting that the abutment screw must be lubricated in saliva to avoid further loosening.

Coating dental implant abutment screws with diamondlike carbon doped with diamond nanoparticles: the effect on maintaining torque after mechanical cycling.

PubMed

Lepesqueur, Laura Soares; de Figueiredo, Viviane Maria Gonçalves; Ferreira, Leandro Lameirão; Sobrinho, Argemiro Soares da Silva; Massi, Marcos; Bottino, Marco Antônio; Nogueira Junior, Lafayette

2015-01-01

To determine the effect of maintaining torque after mechanical cycling of abutment screws that are coated with diamondlike carbon and coated with diamondlike carbon doped with diamond nanoparticles, with external and internal hex connections. Sixty implants were divided into six groups according to the type of connection (external or internal hex) and the type of abutment screw (uncoated, coated with diamondlike carbon, and coated with diamondlike carbon doped with diamond nanoparticles). The implants were inserted into polyurethane resin and crowns of nickel chrome were cemented on the implants. The crowns had a hole for access to the screw. The initial torque and the torque after mechanical cycling were measured. The torque values maintained (in percentages) were evaluated. Statistical analysis was performed using one-way analysis of variance and the Tukey test, with a significance level of 5%. The largest torque value was maintained in uncoated screws with external hex connections, a finding that was statistically significant (P = .0001). No statistically significant differences were seen between the groups with and without coating in maintaining torque for screws with internal hex connections (P = .5476). After mechanical cycling, the diamondlike carbon with and without diamond doping on the abutment screws showed no improvement in maintaining torque in external and internal hex connections.

[Exploratory study of 3D printing technique in the treatment of basilar invagination and atlantoaxial dislocation].

PubMed

Yin, Yiheng; Yu, Xinguang; Tong, Huaiyu; Xu, Tao; Wang, Peng; Qiao, Guangyu

2015-10-06

To investigate the clinical application value of the 3D printing technique in the treatment of basilar invagination and atlantoaxial dislocation. From January 2013 to September 2013, 10 patients with basilar invagination and atlantoaxial dislocation needing posterior fixation undertook 3D printing modes at the Department of Neurosurgery in PLA General Hospital. The 1:1 size models were established from skull base to C4 level with different colors between bone structures and vertebral arteries. The simulation of screw insertion was made to investigate the fixation plan and ideal entry point to avoid vertebral artery injury. After obtaining the individual screw insertion data in 3D printing modes, the according surgical operations were performed. The actual clinical results and virtual screw data in 3D printing mode were compared with each other. The 3D printing modes revealed that all the 10 patients had the dysplasia or occipitalized C1 posterior arch indicating C1 posterior arch screw implantation was not suitable. C1 lateral masses were chosen as the screws entry points. C2 screws were designed individually based on the 3D printing modes as follows: 3 patients with aberrant vertebral artery or narrow C2 pedicle less than 3.5 mm were not suitable for pedicle screw implantation. Among the 3 patients, 1 was fixed with C2 laminar screw, and 1 with C2-3 transarticular screw and 1 with C3 pedicle screw (also combined with congenital C2-3 vertebral fusion). Two patients with narrow C2 pedicle between 3.5 and 4mm were designed to choose pedicle screw fixation after 3D printing mode evaluation. One patient with C1 lateral mass vertically dislocated axis was planned with C1-2 transarticular screw fixation. All the other patients were planned with C2 pedicle screws. All the 10 patients had operation designed as the 3D printing modes schemes. The follow-up ranged from 12 to 18 months and all the patients recovered from the clinical symptoms and the bony fusion attained to 100%. 3D printing mode could provide thorough information of the bony structure abnormalities and route of vertebral artery. It is helpful for setting operation strategy and designing screw entry point and trajectory and avoiding vertebral artery and spinal cord injury and thus deserves generalization.

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis.

PubMed

Schröder, Marc L; Staartjes, Victor E

2017-05-01

OBJECTIVE The accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation. METHODS A retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures. RESULTS Seventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p < 0.001, OR 9.7). Additionally, a higher incidence of revision surgery for screw malposition was observed for freehand procedures than for the robot-guided procedures (p < 0.001, OR 8.1). The VAS score for back pain improved significantly from 66.9 ± 25.0 preoperatively to 30.1 ± 26.8 at the final follow-up, as did the VAS score for leg pain (from 70.6 ± 22.8 to 24.3 ± 28.3) and ODI (from 43.4 ± 18.3 to 16.2 ± 16.7; all p < 0.001). Undergoing PLIF, a high body mass index, smoking status, and a preoperative ability to work were identified as predictors of a reduction in back pain. Length of hospital stay was 2.4 ± 1.1 days and operating time was 161 ± 50 minutes. Ability to work increased from 38.9% to 78.2% of patients (p < 0.001) at the final follow-up, and 89.1% of patients indicated they would choose to undergo the same treatment again. CONCLUSIONS In adults with low-grade spondylolisthesis, the data demonstrated a benefit in using robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other techniques.

Comparison of Neck Screw and Conventional Fixation Techniques in Mandibular Condyle Fractures Using 3-Dimensional Finite Element Analysis.

PubMed

Conci, Ricardo Augusto; Tomazi, Flavio Henrique Silveira; Noritomi, Pedro Yoshito; da Silva, Jorge Vicente Lopes; Fritscher, Guilherme Genehr; Heitz, Claiton

2015-07-01

To compare the mechanical stress on the mandibular condyle after the reduction and fixation of mandibular condylar fractures using the neck screw and 2 other conventional techniques according to 3-dimensional finite element analysis. A 3-dimensional finite element model of a mandible was created and graphically simulated on a computer screen. The model was fixed with 3 different techniques: a 2.0-mm plate with 4 screws, 2 plates (1 1.5-mm plate and 1 2.0-mm plate) with 4 screws, and a neck screw. Loads were applied that simulated muscular action, with restrictions of the upper movements of the mandible, differentiation of the cortical and medullary bone, and the virtual "folds" of the plates and screws so that they could adjust to the condylar surface. Afterward, the data were exported for graphic visualization of the results and quantitative analysis was performed. The 2-plate technique exhibited better stability in regard to displacement of fractures, deformity of the synthesis materials, and minimum and maximum tension values. The results with the neck screw were satisfactory and were similar to those found when a miniplate was used. Although the study shows that 2 isolated plates yielded better results compared with the other groups using other fixation systems and methods, the neck screw could be an option for condylar fracture reduction. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Radiological analysis of minimal safe distance and optimal screw angle to avoid facet violation in open-door laminoplasty using precontoured plate.

PubMed

Min, Woo-Kie; Seo, Il; Na, Sang-Bong; Choi, Young-Seo; Choi, Ji-Yeon

2017-01-01

This study aimed to present radiologic analysis of minimal safe distance (MSD) and optimal screw angle (OSA) that enables to fix screws in a lateral mass safely without facet joint violation in open-door laminoplasty using a plate. A retrospective analysis was made of 22 patients (male: 17; female: 5), average age 62 years. Seventy-nine lateral mass screws were fixed among a total of 158 screws. MSD that doesn't allow 5-mm screws to violate a facet joint was measured for C3-C7 and a comparative analysis was performed. If the MSD is not secured, the OSA to be given to the cephalad direction is calculated to avoid violation of the facet joint. The screws violating inferior facet joints accounted for 34.1% of the screws fixed in inferior lateral mass. Joint surface to distal mini-screw distances were 3.18 ± 1.46 mm and 4.75 ± 1.71 mm in groups of facet joint violation and non-facet violation (FV), respectively ( p = 0.001). When 5-mm screws were inserted into a lateral mass, MSD was 4.39 ± 0.83 mm. The average MSD of C3, C4, and C5 was 4.05 ± 0.78 mm, 4.10 ± 0.70 mm, and 4.26 ± 0.74 mm, respectively. There was no significant differences among levels ( p > 0.05). The average MSD of C6 and C7 was 4.92 ± 0.81 mm and 4.80 ± 0.96 mm, respectively, showing significant differences from those of C3, C4, and C5 ( p < 0.05). If 6 mm of the MSD isn't secured, OSA showed in the cephalad direction of 11.5° for 5 mm and 22° for 4 mm approximately. We suggest that mini-screw on lateral mass can be fixed safely without FV, if they are fixed at MSD of 6 mm from a joint surface. Facet joint violation doesn't occur if an OSA is given in the cephalad direction in case of not enough MSD for mini-screws.

Biomechanics of halo-vest and dens screw fixation for type II odontoid fracture.

PubMed

Ivancic, Paul C; Beauchman, Naseem N; Mo, Fred; Lawrence, Brandon D

2009-03-01

An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture. The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined. Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture. A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1. Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending. The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture.

Biomechanical comparative study of the stability of injectable pedicle screws with different lateral holes augmented with different volumes of polymethylmethacrylate in osteoporotic lumbar vertebrae.

PubMed

Liu, Da; Sheng, Jun; Luo, Yang; Huang, Chen; Wu, Hong-Hua; Zhou, Jiang-Jun; Zhang, Xiao-Jun; Zheng, Wei

2018-03-19

Polymethylmethacrylate (PMMA) is widely used for pedicle screw augmentation in osteoporosis. Until now, there had been no studies of the relationship between screw stability and the distribution and volume of PMMA. The objective of this study was to analyze the relationship between screw stability and the distribution pattern and injected volume of PMMA. This is a biomechanical comparison of injectable pedicle screws with different lateral holes augmented with different volumes of PMMA in cadaveric osteoporotic lumbar vertebrae. Forty-eight osteoporotic lumbar vertebrae were randomly divided into Groups A, B, and C with different pedicle screws (16 vertebrae in each group), and then each group was randomly divided into Subgroups 0, 1, 2, and 3 with different volumes of PMMA (four vertebra with eight pedicles in each subgroup). A pilot hole was prepared in advance using the same method in all samples. Type A and type B pedicle screws were directly inserted into vertebrae in Groups A and B, respectively, and then different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL) were injected through the screws and into vertebrae in Subgroups 0, 1, 2, and 3. The pilot holes were filled with different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL), and then the screws were inserted in Groups C0, C1, C2, and C3. Screw position and distribution of PMMA were evaluated radiographically, and axial pullout tests were performed to measure maximum axial pullout strength (F max ). Polymethylmethacrylate surrounded the anterior one-third of screws in the vertebral body in Groups A1, A2, and A3; the middle one-third of screws in the junction area of the vertebral body and the pedicle in Groups B1, B2, and B3; and the full length of screws evenly in both the vertebral body and the pedicle in Groups C1, C2, and C3. There was no malpositioning of screws or leakage of PMMA in any sample. Two-way analysis of variance revealed that two factors-distribution and volume of PMMA-significantly influenced F max (p<.05) but that they were not significantly correlated (p=.088). F max values in groups using augmentation with PMMA values significantly improved compared with those in groups without PMMA (p<.05). Polymethylmethacrylate can significantly enhance the stability of different injectable pedicle screws in osteoporotic lumbar vertebrae, and screw stability is significantly correlated with the distribution pattern and the injected volume of PMMA. The closer the PMMA to the pedicle and the greater the quantity of injected PMMA, the greater is the pedicle screw stability. Injection of 2.0 mL of PMMA through screws with four lateral 180° holes or of 1.0 mL of PMMA through screws with six lateral 180° holes increases the stability of pedicle screws. Copyright © 2018 Elsevier Inc. All rights reserved.

Fish Research Project Oregon; Aspects of Life History and Production of Juvenile Oncorhynchus Mykiss in the Grande Ronde River Basin, Northeast Oregon, 1995-1999 Summary Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Dyke, Erick S.; Jonnasson, Brian C.; Carmichael, Richard W.

2001-07-01

Rotary screw traps, located at four sites in the Grande Ronde River basin, were used to characterize aspects of early life history exhibited by juvenile Onchorhychus mykiss during migration years 1995-99. The Lostine, Catherine Creek and upper Grande Ronde traps captured fish as they migrated out of spawning areas into valley rearing habitats. The Grande Ronde Valley trap captured fish as they left valley habitats downstream of Catherine Creek and upper Grande Ronde River rearing habitats. Dispersal downstream of spawning areas was most evident in fall and spring, but movement occurred during all seasons that the traps were fished. Seawardmore » migration occurred primarily in spring when O. mykiss smolts left overwintering area located in both spawning area and valley habitats. Migration patterns exhibited by O. mykiss suggest that Grande Ronde Valley habitats are used for overwintering and should be considered critical rearing habitat. We were unable to positively differentiate anadromous and resident forms of O. mykiss in the Grande Ronde River basin because both forms occur in our study area. The Grande Ronde Valley trap provided the best information on steelhead production in the basin because it fished below valley habitats where O. mykiss overwinter. Length frequency histograms of O. mykiss captured below upper spawning and rearing habitats showed a bimodal distribution regardless of the season of capture. Scale analyses suggested that each mode represents a different brood year. Length frequency histograms of O. mykiss captured in the Grande Ronde Valley trap were not bimodal, and primarily represented a size range consistent with other researchers' accounts of anadromous smolts.« less

[Open double-row rotator cuff repair using the LASA-DR screw].

PubMed

Schoch, C; Geyer, S; Geyer, M

2016-02-01

Safe and cost-effective rotator-cuff repair. All types of rotator cuff lesions. Frozen shoulder, rotator cuff mass defect, defect arthropathy. Extensive four-point fixation on the bony footprint is performed using the double-row lateral augmentation screw anchor (LASA-DR) with high biomechanical stability. Following mobilization of the tendons, these are refixed in the desired configuration first medially and then laterally. To this end, two drilling channels (footprint and lateral tubercle) are created for each screw. Using the shuttle technique, a suture anchor screw is reinforced with up to four pairs of threads. The medial row is then pierced and tied, and the sutures that have been left long are tied laterally around the screw heads (double row). 4 Weeks abduction pillow, resulting in passive physiotherapy, followed by initiation of active assisted physiotherapy. Full weight-bearing after 4-6 months. Prospective analysis of 35 consecutive Bateman-III lesions with excellent results and low rerupture rate (6%).

[APPLICATION OF COMPRESSION MINI-SCREWS IN TREATMENT OF PATIENTS WITH INJURY OF ELBOW JOINT BONES].

PubMed

Neverov, V A; Egorov, K S

2015-01-01

A case report presents the experience of application of compression pileateless mini-screws (Gerbert's screws) in treatment of intra-articular fractures, which formed the elbow joint (44 cases). There were performed 32 operations concerning fracture of head of radius, 10 operations on the occasion of fractures of distal section of the humerus and 2 operations on the coronoid process. Long-term treatment results were followed-up in 31 patients during more than 6 months. On basis of analysis of treatment results the authors made a conclusion that the application of mini-screws in case of bone fractures, which formed the elbow joint, allowed realization of stable osteosynthesis after anatomic reposition of articular surfaces, obtaining good anatomical and functional result and shortened the terms of patient's treatment.

Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study.

PubMed

Matityahu, Amir; Kahler, David; Krettek, Christian; Stöckle, Ulrich; Grutzner, Paul Alfred; Messmer, Peter; Ljungqvist, Jan; Gebhard, Florian

2014-12-01

To evaluate the accuracy of computer-assisted sacral screw fixation compared with conventional techniques in the dysmorphic versus normal sacrum. Review of a previous study database. Database of a multinational study with 9 participating trauma centers. The reviewed group included 130 patients, 72 from the navigated group and 58 from the conventional group. Of these, 109 were in the nondysmorphic group and 21 in the dysmorphic group. Placement of sacroiliac (SI) screws was performed using standard fluoroscopy for the conventional group and BrainLAB navigation software with either 2-dimensional or 3-dimensional (3D) navigation for the navigated group. Accuracy of SI screw placement by 2-dimensional and 3D navigation versus conventional fluoroscopy in dysmorphic and nondysmorphic patients, as evaluated by 6 observers using postoperative computerized tomography imaging at least 1 year after initial surgery. Intraobserver agreement was also evaluated. There were 11.9% (13/109) of patients with misplaced screws in the nondysmorphic group and 28.6% (6/21) of patients with misplaced screws in the dysmorphic group, none of which were in the 3D navigation group. Raw agreement between the 6 observers regarding misplaced screws was 32%. However, the percent overall agreement was 69.0% (kappa = 0.38, P < 0.05). The use of 3D navigation to improve intraoperative imaging for accurate insertion of SI screws is magnified in the dysmorphic proximal sacral segment. We recommend the use of 3D navigation, where available, for insertion of SI screws in patients with normal and dysmorphic proximal sacral segments. Therapeutic level I.

3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

PubMed

Xu, Wei; Zhang, Xuming; Ke, Tie; Cai, Hongru; Gao, Xiang

2017-08-11

This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

Polyaxial Screws in Locked Plating of Tibial Pilon Fractures.

PubMed

Yenna, Zachary C; Bhadra, Arup K; Ojike, Nwakile I; Burden, Robert L; Voor, Michael J; Roberts, Craig S

2015-08-01

This study examined the axial and torsional stiffness of polyaxial locked plating techniques compared with fixed-angle locked plating techniques in a distal tibia pilon fracture model. The effect of using a polyaxial screw to cross the fracture site was examined to determine its ability to control relative fracture site motion. A laboratory experiment was performed to investigate the biomechanical stiffness of distal tibia fracture models repaired with 3.5-mm anterior polyaxial distal tibial plates and locking screws. Sawbones Fourth Generation Composite Tibia models (Pacific Research Laboratories, Inc, Vashon, Washington) were used to model an Orthopaedic Trauma Association 43-A1.3 distal tibia pilon fracture. The polyaxial plates were inserted with 2 central locking screws at a position perpendicular to the cortical surface of the tibia and tested for load as a function of axial displacement and torque as a function of angular displacement. The 2 screws were withdrawn and inserted at an angle 15° from perpendicular, allowing them to span the fracture and insert into the opposing fracture surface. Each tibia was tested again for axial and torsional stiffness. In medial and posterior loading, no statistically significant difference was found between tibiae plated with the polyaxial plate and the central screws placed in the neutral position compared with the central screws placed at a 15° position. In torsional loading, a statistically significant difference was noted, showing greater stiffness in tibiae plated with the polyaxial plate and the central screws placed at a 15° position compared with tibiae plated with the central screws placed at a 0° (or perpendicular) position. This study showed that variable angle constructs show similar stiffness properties between perpendicular and 15° angle insertions in axial loading. The 15° angle construct shows greater stiffness in torsional loading. Copyright 2015, SLACK Incorporated.

Clinical Outcomes of Posterior C1 and C2 Screw-Rod Fixation for Atlantoaxial Instability.

PubMed

Işik, Hasan Serdar; Sandal, Evren; Çağli, Sedat

2017-06-14

In this study, we aimed at sharing our experiences and contributing to the literature by making a retrospective analysis of the patients we operated with screw-rod system for atlantoaxial instability in our clinic. Archive files of adult patients, who were operated for posterior C1-C2 stabilization with screw and rod in our clinic between January 2006 and January 2016, were analyzed. 28 patients, who had pre and post-operative images, follow-up forms and who were followed for at least one year, were analyzed. Preoperative clinical and radiological records, preoperative observations, postoperative complications, and clinical responses were evaluated. The average age of 28 patients (F:13 M:19) was 44.7 (21-73). Fixation was performed with C1-C2 screw-rod system on the basis of the following diagnoses; type 2 odontoid fracture (16), basilar invagination (5), C1-C2 instability (5), and atlantoaxial subluxation secondary to rheumatoid arthritis (2). Lateral mass screws were inserted at C1 segment. C2 screws inserted were bilateral pedicle in 12 cases, bilateral pars in 4, bilateral laminar in 8 and one side pars, one side laminar in 4 cases. There was no screw malposition. Neither implant failure nor recurrent instability was observed during follow-up. Significant clinical improvement was reported according to the assessments done with JOA and VAS scores. C1-C2 screw fixation is regarded as a more successful and safe method than other fixation methods in surgical treatment of atlantoaxial instability considering complications, success in reduction, fusion and fixation strength. C2 laminar screw technique is as successful as the other alternatives in fixation and fusion.

Removal torque evaluation of three different abutment screws for single implant restorations after mechanical cyclic loading.

PubMed

Paepoemsin, T; Reichart, P A; Chaijareenont, P; Strietzel, F P; Khongkhunthian, P

2016-01-01

The aim of this study was to evaluate the removal torque of three different abutment screws and pull out strength of implant-abutment connection for single implant restorations after mechanical cyclic loading. The study was performed in accordance with ISO 14801:2007. Three implant groups (n=15) were used: group A, PW Plus® with flat head screw; group B, PW Plus® with tapered screw; and group C, Conelog® with flat head screw. All groups had the same implant-abutment connection feature: cone with mandatory index. All screws were tightened with manufacturer's recommended torque. Ten specimens in each group underwent cyclic loading (1×106 cycles, 10 Hz, and 250 N). Then, all specimens were un-tightened, measured for the removal torque, and underwent a tensile test. The force that dislodged abutment from implant fixture was recorded. The data were analysed using independent sample t-test, ANOVA and Tukey HSD test. Before cyclic loading, removal torque in groups A, B and C were significantly different (B> A> C, P<.05). After cyclic loading, removal torque in all groups decreased significantly (P<.05). Group C revealed significantly less removal torque than groups A and B (P<.005). Tensile force in all groups significantly increased after cyclic loading (P<.05), group A had significantly less tensile force than groups B and C (P<.005). Removal torque reduced significantly after cyclic loading. Before cyclic loading, tapered screws maintained more preload than did flat head screws. After cyclic loading, tapered and flat head screws maintained even amounts of preload. The tensile force that dislodged abutment from implant fixture increased immensely after cyclic loading.

Removal torque evaluation of three different abutment screws for single implant restorations after mechanical cyclic loading

PubMed Central

PAEPOEMSIN, T.; REICHART, P. A.; CHAIJAREENONT, P.; STRIETZEL, F. P.; KHONGKHUNTHIAN, P.

2016-01-01

SUMMARY Purpose The aim of this study was to evaluate the removal torque of three different abutment screws and pull out strength of implant-abutment connection for single implant restorations after mechanical cyclic loading. Methods The study was performed in accordance with ISO 14801:2007. Three implant groups (n=15) were used: group A, PW Plus® with flat head screw; group B, PW Plus® with tapered screw; and group C, Conelog® with flat head screw. All groups had the same implant-abutment connection feature: cone with mandatory index. All screws were tightened with manufacturer’s recommended torque. Ten specimens in each group underwent cyclic loading (1×106 cycles, 10 Hz, and 250 N). Then, all specimens were un-tightened, measured for the removal torque, and underwent a tensile test. The force that dislodged abutment from implant fixture was recorded. The data were analysed using independent sample t-test, ANOVA and Tukey HSD test. Results Before cyclic loading, removal torque in groups A, B and C were significantly different (B> A> C, P<.05). After cyclic loading, removal torque in all groups decreased significantly (P<.05). Group C revealed significantly less removal torque than groups A and B (P<.005). Tensile force in all groups significantly increased after cyclic loading (P<.05), group A had significantly less tensile force than groups B and C (P<.005). Conclusions Removal torque reduced significantly after cyclic loading. Before cyclic loading, tapered screws maintained more preload than did flat head screws. After cyclic loading, tapered and flat head screws maintained even amounts of preload. The tensile force that dislodged abutment from implant fixture increased immensely after cyclic loading. PMID:28042450

Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series.

PubMed

Smith, Brandon W; Joseph, Jacob R; Kirsch, Michael; Strasser, Mary Oakley; Smith, Jacob; Park, Paul

2017-08-01

OBJECTIVE Percutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy. METHODS Patients undergoing PPSI utilizing the K-wire-less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement. RESULTS Thirty-six patients (18 male and 18 female) were included. The patients' mean age was 60.4 years (range 23.8-78.4 years), and their mean body mass index was 28.5 kg/m 2 (range 20.8-40.1 kg/m 2 ). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4-14) were placed over a mean of 2.61 levels (range 1-7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort. CONCLUSIONS This streamlined 2-step K-wire-less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

Three-dimensional knee motion before and after high tibial osteotomy for medial knee osteoarthritis.

PubMed

Takemae, Takashi; Omori, Go; Nishino, Katsutoshi; Terajima, Kazuhiro; Koga, Yoshio; Endo, Naoto

2006-11-01

High tibial osteotomy (HTO) is an established surgical option for treating medial knee osteoarthritis. HTO moves the mechanical load on the knee joint from the medial compartment to the lateral compartment by changing the leg alignment, but the effects of the operation remain unclear. The purpose of this study was to evaluate the change in three-dimensional knee motion before and after HTO, focusing on lateral thrust and screw home movement, and to investigate the relationship between the change in knee motion and the clinical results. A series of 19 patients with medial knee osteoarthritis who had undergone HTO were evaluated. We performed a clinical assessment, radiological evaluation, and motion analysis at 2.4 years postoperatively. The clinical assessment was performed using the Japanese Orthopaedic Association knee score. The score was significantly improved in all patients after operation. Motion analysis revealed that lateral thrust, which was observed in 18 of the 20 knees before operation, was reduced to 7 knees after operation. Regarding active terminal extension of the knee, three patterns of rotational movement were observed before operation: screw home movement (external rotation), reverse screw home movement (internal rotation), and no rotation. By contrast, after operation, only reverse screw home movement and no rotation were observed; the screw home movement disappeared in all patients. In the knees with reverse screw home movement after operation, the preoperative score was significantly lower than those in the knees with no rotation after operation. Kinetically, HTO was useful for suppressing lateral thrust in medial knee osteoarthritis, although the rotational movement of the knee joint was unchanged.

Influence of abutment screw preload on stress distribution in marginal bone.

PubMed

Khraisat, Ameen

2012-01-01

Changes in an implant assembly after abutment connection might possibly cause deformation in the implant/abutment joint and even in the marginal bone. The aim of this study was to evaluate the influence of abutment screw preload through the implant collar on marginal bone stress without external load application. Models of three implant parts made of titanium (implant, abutment, and abutment screw) and cortical bone were built and positioned with computer-aided design software. Meshing and generation of boundary conditions, loads, and interactions were performed. Each part was meshed independently. The sole load applied to the model was a torque of 32 Ncm on the abutment screw about its axis of rotation. The implant collar was deformed axially after the screw was tightened (3 μm). This deformation resulted in 60 MPa of stress in the marginal bone. Moreover, pressure on the marginal bone in a radial direction was observed. It can be concluded that, without any external load application, abutment screw preload exerts stresses on the implant collar and the marginal bone. These findings should help guide the development of new implant/abutment joint designs that exert less stress on the marginal bone.

Accuracy of pedicle screw placement in patients with Marfan syndrome.

PubMed

Qiao, Jun; Zhu, Feng; Xu, Leilei; Liu, Zhen; Sun, Xu; Qian, Bangping; Jiang, Qing; Zhu, Zezhang; Qiu, Yong

2017-03-21

There is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome. CT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1-4.0 mm as Grade 2, 4.1-6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable. 976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P < 0.05), higher in lumbar region than in thoracic region (34.1% VS. 22.3%, P < 0.05) and higher in concave side than in convex side (33.5% VS. 21.9%, P < 0.05). No injury of visceral organs especially aorta erosion was noted in the series. 7 cases of dural tear caused by misplaced screws occurred, and 4 cases developed cerebro-spinal fluid leak. Drainage and pressure dressings were applied for these patients, and no infection was observed. Leg pain was observed in 7 cases, and 2 cases simultaneously complained of leg weakness. Revision surgery was conducted to remove the misplaced screws for these 2 patients. Conservative treatment was applied for the 5 patients without leg weakness. Symptoms of leg weakness and pain resolved in all patients. Placement of pedicle screw in Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

Blade number impact on pressure and performance of archimedes screw turbine using CFD

NASA Astrophysics Data System (ADS)

Maulana, Muhammad Ilham; Syuhada, Ahmad; Nawawi, Muhammad

2018-02-01

Many rivers in Indonesia can be used as source of mini/micro hydro power plant using low head turbine. The most suitable type of turbine used in fluid flow with low head is the Archimedes screw turbine. The Archimedes screw hydro turbine is a relative newcomer to the small-scale hydropower that can work efficiently on heads as low as 10 meter. In this study, the performance of Archimedes water turbines that has different blade numbers that are thoroughly evaluated to obtain proper blade configuration. For this purpose, numerical simulations are used to predict the pressure changes that occur along the turbine. The simulation results show that turbines with an amount of two blades have more sloping pressure distribution so that it has better stability.

Influence of panel fastening on the acoustic performance of light-weight building elements: Study by sound transmission and laser scanning vibrometry

NASA Astrophysics Data System (ADS)

Roozen, N. B.; Muellner, H.; Labelle, L.; Rychtáriková, M.; Glorieux, C.

2015-06-01

Structural details and workmanship can cause considerable differences in sound insulation properties of timber frame partitions. In this study, the influence of panel fastening is investigated experimentally by means of standardized sound reduction index measurements, supported by detailed scanning laser Doppler vibrometry. In particular the effect of the number of screws used to fasten the panels to the studs, and the tightness of the screws, is studied using seven different configurations of lightweight timber frame building elements. In the frequency range from 300 to 4000 Hz, differences in the weighted sound reduction index RW as large as 10 dB were measured, suggesting that the method of fastening can have a large impact on the acoustic performance of building elements. Using the measured vibrational responses of the element, its acoustic radiation efficiency was computed numerically by means of a Rayleigh integral. The increased radiation efficiency partly explains the reduced sound reduction index. Loosening the screws, or reducing the number of screws, lowers the radiation efficiency, and significantly increases the sound reduction index of the partition.

Analysis of plastic deformation in cortical bone after insertion of coated and non-coated self-tapping orthopaedic screws.

PubMed

Koistinen, A P; Korhonen, H; Kiviranta, I; Kröger, H; Lappalainen, R

2011-07-01

Insertion of internal fracture fixation devices, such as screws, mechanically weakens the bone. Diamond-like carbon has outstanding tribology properties which may decrease the amount of damage in tissue. The purpose of this study was to investigate methods for quantification of cortical bone damage after orthopaedic bone screw insertion and to evaluate the effect of surface modification on tissue damage. In total, 48 stainless steel screws were inserted into cadaver bones. Half of the screws were coated with a smooth amorphous diamond coating. Geometrical data of the bones was determined by peripheral quantitative computed tomography. Thin sections of the bone samples were prepared after screw insertion, and histomorphometric evaluation of damage was performed on images obtained using light microscopy. Micro-computed tomography and scanning electron microscopy were also used to examine tissue damage. A positive correlation was found between tissue damage and the geometric properties of the bone. The age of the cadaver significantly affected the bone mineral density, as well as the damage perimeter and diameter of the screw hole. However, the expected positive effect of surface modification was probably obscured by large variations in the results and, thus, statistically significant differences were not found in this study. This can be explained by natural variability in bone tissue, which also made automated image analysis difficult.

Screw vs cement-implant-retained restorations: an experimental study in the beagle. Part 2. Immunohistochemical evaluation of the peri-implant tissues.

PubMed

Assenza, Bartolomeo; Artese, Luciano; Scarano, Antonio; Rubini, Corrado; Perrotti, Vittoria; Piattelli, Maurizio; Thams, Ulf; San Roman, Fidel; Piccirilli, Marcello; Piattelli, Adriano

2006-01-01

Crestal bone loss has been reported to occur around dental implants. Even if the causes of this bone loss are not completely understood, the presence of a microgap between implant and abutment with a possible contamination of the internal portion of the implants has been suggested. The aim of this study was to see if there were differences in the vascular endothelial growth factor (VEGF) expression, microvessel density (MVD), proliferative activity (MIB-1), and inflammatory infiltrate in the soft tissues around implants with screwed and cemented abutments. Sandblasted and acid-etched implants were inserted in the mandibles of 6 Beagle dogs. Ten 3.5- x 10-mm root-form implants were inserted in each mandible. A total of 60 implants (30 with screwed abutments and 30 with cemented abutments) were used. After 12 months, all the bridges were removed and all abutments were checked for mobility. A total of 8 loosened screws (27%) were found in the screwed abutments, whereas no loosening was observed in cemented abutments. A gingival biopsy was performed in 8 implants with cemented abutments, in 8 implants with screwed abutments, and in 8 implants with unscrewed abutments. No statistically significant differences were found in the inflammatory infiltrate and in the MIB-1 among the different groups. No statistically significant difference was found in the MVD between screwed and cemented abutments (P = .2111), whereas there was a statistically significant difference in MVD between screwed and unscrewed abutments (P = .0277) and between cemented and unscrewed abutments (P = .0431). A low intensity of VEGF was prevalent in screwed and in cemented abutments, whereas a high intensity of VEGF was prevalent in unscrewed abutments. These facts could be explained by the effects induced, in the abutments that underwent a screw loosening, by the presence of bacteria inside the hollow portion of the implants or by enhanced reparative processes.

[Surgical Correction of Scoliosis: Does Intraoperative CT Navigation Prolong Operative Time?

PubMed

Skála-Rosenbaum, J; Ježek, M; Džupa, V; Kadeřábek, R; Douša, P; Rusnák, R; Krbec, M

2016-01-01

PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.

Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis.

PubMed

Zhang, Ya-Kui; Wei, Hung-Wen; Lin, Kang-Ping; Chen, Wen-Chuan; Tsai, Cheng-Lun; Lin, Kun-Jhih

2016-06-01

Locking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included "locking and dynamic holes separated" and "locking hole only" configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate. Finite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A "virtual" subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison. The mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6N/mm) compared with the combi design (115.0N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design. The computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Calcium Triglyceride Versus Polymethylmethacrylate Augmentation: A Biomechanical Analysis of Pullout Strength.

PubMed

Hickerson, Lindsay E; Owen, John R; Wayne, Jennifer S; Tuten, H Robert

2013-01-01

Biomechanical pullout study using calcium triglyceride (CTG) and polymethylmethacrylate (PMMA) for screw augmentation. Compare the biomechanical performance of CTG augmentation versus the gold standard, PMMA, in primary and revision models, using a pedicle screw pullout model. CTG is a novel form of bone augmentation with several reported biocompatible properties compared with PMMA. PMMA is the standard of care for pedicle screw augmentation in osteoporotic spine. Blocks of closed-cell rigid polyurethane foam of uniform density, representing subcortical layer in osteoporotic pedicle, were prepared according to ASTM standards. After the components of PMMA (n = 11) and CTG (n = 11) were individually mixed in a standardized fashion, 0.2 ml was injected from deep to superficial along a predrilled pilot hole followed by immediate insertion of the pedicle screw. An unaugmented group (n = 10) was also prepared. Blocks cured for 24 hrs, and screws were pulled out at a rate of 5 mm/min on materials testing equipment. For the revision model, the unaugmented group, after screw pullout, was augmented with 0.8 ml of PMMA (n = 5) or CTG (n = 5) as detailed above and screw pullout performed similarly. The mean pullout strengths (SD) for the intact models were as follows: unaugmented, 976.6 N (94.2 N); PMMA, 1,218.1 N (66.8 N); and CTG, 1,841.6 N (57.4 N). A one-way analysis of variance indicated a significant difference among the primary models (p < .0001). For the revision models, the pullout strength for PMMA was 1,939.2 N (108.9 N) and for CTG, 2,513.0 N (149.1 N), which were statistically different from each other (p < .0003). Stiffness of the constructs was increased with both PMMA and CTG augmentation over no augmentation (p < .0001) although no significant difference in stiffness was detected between the 2 forms of augmentation. We conclude that CTG augmentation of pedicle screws resulted in significantly higher axial pullout strength in primary (p < .0001) and revision (p < .0003) models compared with PMMA. Copyright © 2013 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Impact of fill-level in twin-screw granulation on critical quality attributes of granules and tablets.

PubMed

Meier, Robin; Moll, Klaus-Peter; Krumme, Markus; Kleinebudde, Peter

2017-06-01

In a previous study a change of the fill-level in the barrel exerted a huge influence on the twin-screw granulation (TSG) process of a high drug loaded, simplified formulation. The present work investigated this influence systematically. The specific feed load (SFL) indicating the mass per revolution as surrogate parameter for the fill-level was applied and the correlation to the real volumetric fill level of an extruder could be demonstrated by a newly developed method. A design of experiments was conducted to examine the combined influence of SFL and screw speed on the process and on critical quality attributes of granules and tablets. The same formulation was granulated at constant liquid level with the same screw configuration and led to distinctively different results by only changing the fill-level and the screw speed. The power consumption of the extruder increased at higher SFLs with hardly any influence of screw speed. At low SFL the median residence time was mainly fill-level dependent and at higher SFL mainly screw speed dependent. Optimal values for the product characteristics were found at medium values for the SFL. Granule size distributions shifted from mono-modal and narrow shape to broader and even bimodal distributions of larger median granule sizes, when exceeding or falling below a certain fill-level. Deviating from the optimum fill-level, tensile strength of tablets decreased by about 25% and disintegration times of tablets increased for more than one third. At low fill-levels, material accumulation in front of the kneading zone was detected by pressure measurements and was assumed to be responsible for the unfavored product performance. At high fill-levels, granule consolidation due to higher propensity of contact with the result of higher material temperature was accounted for inferior product performance. The fill-level was found to be an important factor in assessment and development of twin-screw granulation processes as it impacted process and product attributes enormously. Copyright © 2017 Elsevier B.V. All rights reserved.

The influence of distal screw length on the primary stability of volar plate osteosynthesis--a biomechanical study.

PubMed

Baumbach, Sebastian F; Synek, Alexander; Traxler, Hannes; Mutschler, Wolf; Pahr, Dieter; Chevalier, Yan

2015-09-08

Extensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100% distal screw lengths in VLPO. A biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100% (group A) and 75% (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75% was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation. Nine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°). The 75% distal screw length in VLPO provides similar primary stability to 100% unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured.

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model.

PubMed

Osterhoff, Georg; Dodd, Andrew E; Unno, Florence; Wong, Angus; Amiri, Shahram; Lefaivre, Kelly A; Guy, Pierre

2016-11-01

Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10.4) or transsacral group (5.6 mm, range, 3.8-10.5) (p = 0.031). There was no difference with the numbers available in the median number of cycles needed until failure; this was 2921 cycles (range, 2586-5450) in the cemented group, 2570 cycles (range, 2500-5107) for the sacroiliac specimens, and 2578 cycles (range, 2540-2623) in the transsacral group (p = 0.153). The cemented group absorbed more energy before failure (8.2 × 10 5 N*cycles; range, 6.6 × 10 5 -22.6 × 10 5 ) compared with the transsacral group (6.5 × 10 5 N*cycles; range, 6.4 × 10 5 -6.7 × 10 5 ) (p = 0.016). There was no difference with the numbers available in terms of fracture site motion (sacroiliac: 2.9 mm, range, 0.7-5.4; cemented: 1.2 mm, range, 0.6-1.9; transsacral: 2.1 mm, range, 1.2-4.8). Probability values for all between-group comparisons were greater than 0.05. The addition of cement to standard sacroiliac screw fixation seemed to change the mode and dynamics of failure in this cadaveric mechanical model. Although no advantages to cement were observed in terms of screw motion or cycles to failure among the different constructs, a cemented, two-screw sacroiliac screw construct resulted in less screw subsidence and greater energy absorbed to failure than an uncemented single transsacral screw. In osteoporotic bone, the addition of cement to sacroiliac screw fixation might improve screw anchorage. However, larger mechanical studies using these findings as pilot data should be performed before applying these preliminary findings clinically.

Viscoelastic stability in a single-screw channel flow

NASA Astrophysics Data System (ADS)

Agbessi, Y.; Bu, L. X.; Béreaux, Y.; Charmeau, J.-Y.

2018-05-01

In this work, we perform a linear stability analysis on pressure and drag flows of an Upper Convected Maxwell viscoelastic fluid. We use the well-recognised method of expanding the disturbances in Chebyschev polynomials and solve the resulting generalized eigenvalues problem with a collocation spectra method. Both the level of elasticity and the back-pressure vary. In a second stage, recent analytic solutions of viscoelastic fluid flows in slowly varying sections [1] are used to extend this stability analysis to flows in a compression or in a diverging section of a single screw channel, for example a wave mixing screw.

Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: single center experience in treating posterior pelvic instability.

PubMed

Fischer, Sebastian; Vogl, Thomas J; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L; Scholtz, Jan-Erik; Mack, Martin G; Schmidt, Sven; Eichler, Katrin

2015-02-01

The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. 100 guidewires and hollow titan screws were inserted in 38 patients (49.6±19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. The mean minimal distance between guidewire and adjacent neural foramina was 4.5±2.01mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6±0.53mm to 1.2±0.54mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7mGycm). The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Proposal for a new trajectory for subaxial cervical lateral mass screws.

PubMed

Amhaz-Escanlar, Samer; Jorge-Mora, Alberto; Jorge-Mora, Teresa; Febrero-Bande, Manuel; Diez-Ulloa, Maximo-Alberto

2018-06-20

Lateral mass screws combined with rods are the standard method for posterior cervical spine subaxial fixation. Several techniques have been described, among which the most used are Roy Camille, Magerl, Anderson and An. All of them are based on tridimensional angles. Reliability of freehand angle estimation remains poorly investigated. We propose a new technique based on on-site spatial references and compare it with previously described ones assessing screw length and neurovascular potential complications. Four different lateral mass screw insertion techniques (Magerl, Anderson, An and the new described technique) were performed bilaterally, from C3 to C6, in ten human spine specimens. A drill tip guide wire was inserted as originally described for each trajectory, and screw length was measured. Exit point was examined, and potential vertebral artery or nerve root injury was assessed. Mean screw length was 14.05 mm using Magerl's technique, 13.47 mm using Anderson's, 12.8 mm using An's and 17.03 mm using the new technique. Data analysis showed significantly longer lateral mass screw length using the new technique (p value < 0.00001). Nerve potential injury occurred 37 times using Magerl's technique, 28 using Anderson's, 13 using An's and twice using the new technique. Vertebral artery potential injury occurred once using Magerl's technique, 8 times using Anderson's and none using either An's or the new proposed technique. The risk of neurovascular complication was significantly lower using the new technique (p value < 0.01). The new proposed technique allows for longer screws, maximizing purchase and stability, while lowering the complication rate.

Effect of retorque on loosening torque of prosthetic screws under two levels of fit of implant-supported dentures.

PubMed

Spazzin, Aloísio Oro; Henrique, Guilherme Elias Pessanha; Nóbilo, Mauro Antônio de Arruda; Consani, Rafael Leonardo Xediek; Correr-Sobrinho, Lourenço; Mesquita, Marcelo Ferraz

2010-01-01

This study evaluated the influence of retorque on loosening torque (Lt) of prosthetic screws in implant-supported dentures with different fit levels. Ten mandibular implant-supported dentures were fabricated and then 20 cast models were then prepared using prosthetic structures to create 2 fit levels: passive fit (Pf) and misfit (Mf). Two tightening techniques were also evaluated: initial torque only (T1); and initial torque and retorque after 10 min (T2). Gold or titanium screws were used, resulting in 4 groups to each one: Pf/T1, Pf/T2, Mf/T1, Mf/T2. The Lt was measured 24 h after the tightening torque using digital torque meter. Data were analyzed statistically by two-way ANOVA and Tukey's test (alpha=0.05), separately for each screw material. For titanium screws, no significant difference (p>0.05) was found between Pf/T1 and Pf/T2, or between Pf/T2 and Mf/T2. However, statistically significant difference (p<0.05) was found between Pf/T1 and Mf/T1, and between Mf/T1 and Mf/T2. Mf reduced the Lt using T1, while and T2 increased the Lt for Mf. Retorque and fit were shown to have no significant influence on the Lt of the gold screws. Retorque application made insignificant the misfit effect on the Lt of the titanium screws, suggesting that this procedure should be performed routinely during the screw tightening in multi-unit dentures.

Alternative radiation-free registration technique for image-guided pedicle screw placement in deformed cervico-thoracic segments.

PubMed

Kantelhardt, Sven R; Neulen, Axel; Keric, Naureen; Gutenberg, Angelika; Conrad, Jens; Giese, Alf

2017-10-01

Image-guided pedicle screw placement in the cervico-thoracic region is a commonly applied technique. In some patients with deformed cervico-thoracic segments, conventional or 3D fluoroscopy based registration of image-guidance might be difficult or impossible because of the anatomic/pathological conditions. Landmark based registration has been used as an alternative, mostly using separate registration of each vertebra. We here investigated a routine for landmark based registration of rigid spinal segments as single objects, using cranial image-guidance software. Landmark based registration of image-guidance was performed using cranial navigation software. After surgical exposure of the spinous processes, lamina and facet joints and fixation of a reference marker array, up to 26 predefined landmarks were acquired using a pointer. All pedicle screws were implanted using image guidance alone. Following image-guided screw placement all patients underwent postoperative CT scanning. Screw positions as well as intraoperative and clinical parameters were retrospectively analyzed. Thirteen patients received 73 pedicle screws at levels C6 to Th8. Registration of spinal segments, using the cranial image-guidance succeeded in all cases. Pedicle perforations were observed in 11.0%, severe perforations of >2 mm occurred in 5.4%. One patient developed a transient C8 syndrome and had to be revised for deviation of the C7 pedicle screw. No other pedicle screw-related complications were observed. In selected patients suffering from pathologies of the cervico-thoracic region, which impair intraoperative fluoroscopy or 3D C-arm imaging, landmark based registration of image-guidance using cranial software is a feasible, radiation-saving and a safe alternative.

PMMA-augmented SI screw: a biomechanical analysis of stiffness and pull-out force in a matched paired human cadaveric model.

PubMed

Grechenig, Stephan; Gänsslen, Axel; Gueorguiev, Boyko; Berner, Arne; Müller, Michael; Nerlich, Michael; Schmitz, Paul

2015-10-01

Current literature data and clinical experience show that the number of pelvic fractures continuously rises due to the increasing elderly population. In the elderly with suspected osteoporosis additional implant augmentation with bone cement seems to be an option to avoid secondary displacement. There are no reported biomechanical data in the literature comparing the fixation strength (and anchorage) of standard and augmented SI screws so far. The purpose of this study was to assess the biomechanical performance of cement-augmented versus non-augmented SI screws in a human cadaveric pelvis model. Six human cadaveric pelvises preserved with the method of Thiel were used in this study. Each pelvis was split to a pair of 2 hemi-pelvises, assigned to 2 different groups for instrumentation with one non-augmented or one contralateral cement-augmented SI screw, placed in the body of S1 in a randomized fashion. The osteosynthesis followed a standard procedure with 3D controlled percutaneous iliosacral screw positioning. A biomechanical setup for a quasistatic pullout test of each SI screw was used. Construct stiffness and maximum pullout force were calculated from the load-displacement curve of the machine data. Statistical evaluation was performed at a level of significance p = .05 for all statistical tests. Stiffness and pullout force in the augmented group (501.6 N/mm ± 123.7, 1336.8 N ± 221.1) were significantly higher than in the non-augmented one (289.7 N/mm ± 97.1, 597.7 N ± 115.5), p = .04 and p = .014, respectively. BMD influenced significantly the pullout force in all study groups. Cement augmentation significantly increased the fixation strength in iliosacral screw osteosynthesis of the sacrum in a biomechanical human cadaveric model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Biomechanical characteristics of fixation methods for floating pubic symphysis.

PubMed

Song, Wenhao; Zhou, Dongsheng; He, Yu

2017-03-07

Floating pubic symphysis (FPS) is a relatively rare injury caused by high-energy mechanisms. There are several fixation methods used to treat FPS, including external fixation, subcutaneous fixation, internal fixation, and percutaneous cannulated screw fixation. To choose the appropriate fixation, it is necessary to study the biomechanical performance of these different methods. The goal of this study was to compare the biomechanical characteristics of six methods by finite element analysis. A three-dimensional finite element model of FPS was simulated. Six methods were used in the FPS model, including external fixation (Ext), subcutaneous rod fixation (Sub-rod), subcutaneous plate fixation (Sub-plate), superior pectineal plate fixation (Int-sup), infrapectineal plate fixation (Int-ifa), and cannulated screw fixation (Int-scr). Compressive and rotational loads were then applied in all models. Biomechanical characteristics that were recorded and analyzed included construct stiffness, micromotion of the fracture gaps, von Mises stress, and stress distribution. The construct stiffness of the anterior pelvic ring was decreased dramatically when FPS occurred. Compressive stiffness was restored by the three internal fixation and Sub-rod methods. Unfortunately, rotational stiffness was not restored satisfactorily by the six methods. For micromotion of the fracture gaps, the displacement was reduced significantly by the Int-sup and Int-ifa methods under compression. The internal fixation methods and Sub-plate method performed well under rotation. The maximum von Mises stress of the implants was not large. For the plate-screw system, the maximum von Mises stress occurred over the region of the fracture and plate-screw joints. The maximum von Mises stress appeared on the rod-screw and screw-bone interfaces for the rod-screw system. The present study showed the biomechanical advantages of internal fixation methods for FPS from a finite element view. Superior stabilization of the anterior pelvic ring and fracture gaps was obtained by internal fixation. Subcutaneous fixation had satisfactory outcomes as well. Sub-rod fixation offered good anti-compression, while the Sub-plate fixation provided favorable anti-rotational capacity.

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

PubMed Central

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-01-01

Study Design. A cadaveric laboratory study. Objective. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Summary of Background Data. Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. Methods. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. Results. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. Conclusion. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. Level of Evidence: N/A PMID:27513166

In vitro performance and fracture resistance of CAD/CAM-fabricated implant supported molar crowns.

PubMed

Rosentritt, Martin; Hahnel, Sebastian; Engelhardt, Frank; Behr, Michael; Preis, Verena

2017-05-01

The aim of this study is to investigate the performance and fracture resistance of different CAD/CAM ceramic and composite materials as implant- or tooth-supported single crowns with respect to the clinical procedure (screwed/bonded restoration). One hundred twenty crowns were fabricated on implants or human molar teeth simulating (a) chairside procedure ([CHAIR] implant crown bonded to abutment), (b) labside procedure ([LAB] abutment and implant crown bonded in laboratory, screwed chairside), and (c) reference ([TOOTH] crowns luted on human teeth). Four materials were investigated: ZLS (zirconia-reinforced lithium silicate ceramic; Celtra Duo, Degudent: polished (P)/crystallized (C)), RB (resin-based composite; Cerasmart, GC), and RIC (resin-infiltrated ceramic; Enamic, Vita-Zahnfabrik). LiS (lithiumdisilicate; Emax CAD, Ivoclar-Vivadent) served as reference. Combined thermal cycling and mechanical loading (TCML) was performed simulating a 5-year clinical situation. Fracture force was determined. Data were statistically analyzed (Kolmogorov-Smirnov test, one-way ANOVA; post hoc Bonferroni, α = 0.05). One crown of ZLS_C[LAB] (1,200,000 cycles) and RB[CHAIR] (890 cycles) failed during TCML. Fracture values varied between 977.7 N(RB) and 3070.4 N(LiS)[CHAIR], 1130.6 N(RB) and 2998.1 N(LiS)[LAB], and 1802.4 N(ZLS) and 2664.3 N(LiS)[TOOTH]. Significantly (p < 0.003) different forces were found between the materials in all three groups. ZLS_C, RIC, and RB showed significantly (p < 0.014) different values for the individual groups. Partly ceramic and resin-based materials performed differently on implant or tooth abutments. The insertion of a screw channel reduced the stability for individual crown materials. Insertion of the screw channel should be performed carefully. All restorations were in a range where clinical application seems not restricted, but insertion of a screw channel might reduce stability of individual materials.

Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality.

PubMed

Martín-Fernández, M; López-Herradón, A; Piñera, A R; Tomé-Bermejo, F; Duart, J M; Vlad, M D; Rodríguez-Arguisjuela, M G; Alvarez-Galovich, L

2017-08-01

Dramatic increases in the average life expectancy have led to increases in the variety of degenerative changes and deformities observed in the aging spine. The elderly population can present challenges for spine surgeons, not only because of increased comorbidities, but also because of the quality of their bones. Pedicle screws are the implants used most commonly in spinal surgery for fixation, but their efficacy depends directly on bone quality. Although polymethyl methacrylate (PMMA)-augmented screws represent an alternative for patients with osteoporotic vertebrae, their use has raised some concerns because of the possible association between cement leakages (CLs) and other morbidities. To analyze potential complications related to the use of cement-augmented screws for spinal fusion and to investigate the effectiveness of using these screws in the treatment of patients with low bone quality. A retrospective single-center study. This study included 313 consecutive patients who underwent spinal fusion using a total of 1,780 cement-augmented screws. We analyzed potential complications related to the use of cement-augmented screws, including CL, vascular injury, infection, screw extraction problems, revision surgery, and instrument failure. There are no financial conflicts of interest to report. A total of 1,043 vertebrae were instrumented. Cement leakage was observed in 650 vertebrae (62.3%). There were no major clinical complications related to CL, but two patients (0.6%) had radicular pain related to CL at the S1 foramina. Of the 13 patients (4.1%) who developed deep infections requiring surgical debridement, two with chronic infections had possible spondylitis that required instrument removal. All patients responded well to antibiotic therapy. Revision surgery was performed in 56 patients (17.9%), most of whom had long construction. A total of 180 screws were removed as a result of revision. There were no problems with screw extraction. These results demonstrate the efficacy and safety of cement-augmented screws for the treatment of patients with low bone mineral density. Copyright © 2017 Elsevier Inc. All rights reserved.

Functional outcomes following syndesmotic fixation: A comparison of screws retained in situ versus routine removal - Is it really necessary?

PubMed

Tucker, Adam; Street, Julia; Kealey, David; McDonald, Sinead; Stevenson, Mike

2013-12-01

Syndesmotic disruption can occur in up to 20% of ankle fractures and is more common in Weber Type C injuries. Syndesmotic repair aims to restore ankle stability. Routine removal of syndesmosis screws is advocated to avoid implant breakage and adverse functional outcome such as pain and stiffness, but conflicting evidence exists to support this. The aim of the current study is to determine whether functional outcome differs in patients who had syndesmosis screws routinely removed, compared to those who did not, and whether a cost benefit exists if removal of screws is not routinely necessary. A retrospective review of consecutive syndesmosis repairs was performed from 1 January 2008 to 31 December 2010 in a single regional trauma centre. We identified 91 patients who had undergone open reduction internal fixation of an ankle fracture with placement of a syndesmosis screw at index procedure. As many as 69 patients were eligible for the study as defined by the inclusion criteria and they completed a validated functional outcome questionnaire. The functional outcomes of patients with 'retained screws' and 'removed screws' were analysed and compared using the Olerud Molander Ankle Score (OMAS). A total of 63 patients responded with a mean follow-up period of 31 months (range 10-43 months). Of those patients, 43 underwent routine screw removal whilst 20 had screws left in situ. The groups were comparable considering age, gender and follow-up time. The 'retained' group scored higher mean OMAS scores, 81.5±19.3 compared to 75±12.9 in the 'removed' group (p=0.107). The retained group achieved higher functional scores in each of the OMAS domains as well as experiencing less pain. When adjusted for gender, the findings were found to be statistically significant (p=0.046). Our study has shown that retained-screw fixation does not significantly impair functional capacity, with additional cost-effectiveness. We therefore advocate that syndesmosis screws be left in situ and should only be removed in case of symptomatic implants beyond 6 months postoperatively. Copyright © 2013 Elsevier Ltd. All rights reserved.

Foundations for computer simulation of a low pressure oil flooded single screw air compressor

NASA Astrophysics Data System (ADS)

Bein, T. W.

1981-12-01

The necessary logic to construct a computer model to predict the performance of an oil flooded, single screw air compressor is developed. The geometric variables and relationships used to describe the general single screw mechanism are developed. The governing equations to describe the processes are developed from their primary relationships. The assumptions used in the development are also defined and justified. The computer model predicts the internal pressure, temperature, and flowrates through the leakage paths throughout the compression cycle of the single screw compressor. The model uses empirical external values as the basis for the internal predictions. The computer values are compared to the empirical values, and conclusions are drawn based on the results. Recommendations are made for future efforts to improve the computer model and to verify some of the conclusions that are drawn.

Treatment of unicameral calcaneal bone cysts in children: review of literature and results using a cannulated screw for continuous decompression of the cyst.

PubMed

Saraph, Vinay; Zwick, Ernst-Bernhard; Maizen, Claudia; Schneider, Frank; Linhart, Wolfgang E

2004-01-01

Nine unicameral bone cysts of the calcaneus in children were managed surgically using the technique of continuous decompression with titanium cannulated cancellous screws. The average age of the patients at surgery was 12.8 years. At follow-up a minimum of 2 years after surgery, eight cysts showed complete healing; one patient showed healing with residuals. Irritation at the screw insertion site necessitated early removal of the screw in one patient; implant-related problems were not observed in the other patients. Patients were allowed to bear weight after surgery. Implant extraction was performed after full consolidation of the cyst and was uneventful in all patients. A review of the literature and the different treatment modalities used for managing calcaneal cysts is also presented.

Computational study on the influence of number of threads on the performance of single screw pump at high angular velocities

NASA Astrophysics Data System (ADS)

Philip, Jaison; Suryan, Abhilash; Sanand, T. V.; Unnikrishnan Nair, P.; Sivakumar, S.

2017-02-01

Fluid flow in a screw pump which rotates at very high angular velocity is numerically analyzed. In the present study, fluid flow in screw pumps under high Reynolds number, of the order of 105, is considered. Screw pump has two major elements, a plain shroud which is a stationary element and a rotating hub with helical grooves contained within the shroud. In this paper, three variants of hubs with different number of thread starts numbering six, eight and twelve in combination with a plain shroud is studied. Each of the three possible combinations are analyzed on the basis of pressure rise developed, efficiency and shaft power. It was seen that pressure rise, efficiency and shaft power increases as the number of threads increases in the range of mass flow rates studied.

Angle to grain strength of dowel-type fasteners

Treesearch

Lawrence A. Soltis; Suparman Karnasudirdja; James K. Little

1987-01-01

Timber structures require adequate connections between components. Connection design is based on the performance criterion of a single fastener. This study is part of a research effort by the Forest Products Laboratory to establish a common basis design criteria for lateral strength of dowel-type fasteners that includes nails, screws, lag screws, and bolts. A general...

Accuracy of a dynamic surgical guidance probe for screw insertion in the cervical spine: a cadaveric study.

PubMed

Dixon, Daniel; Darden, Bruce; Casamitjana, Jose; Weissmann, Karen A; Cristobal, San; Powell, David; Baluch, Daniel

2017-04-01

A fresh frozen cadaver study was conducted. To report the cortical breach rate using the dynamic surgical guidance (DSG) probe versus traditional freehand technique for cervical lateral mass, cervical pedicle and cervical laminar screws. Nine male fresh frozen cadaveric torsos were utilized for this study. Each investigator was assigned three specimens that were randomized by fixation point, side and order of technique for establishing a screw pilot hole. The technique for screw hole preparation utilized was either a DSG probe in the "on" mode or in the "off" mode using a freehand technique popularized by Lenke et al. Levels instrumented included C1 lateral mass, C2 pedicle screws and lamina screws, and C6-T1 pedicle screws. Fluoroscopy and other navigational assistance were not used for screw hole preparation or screw insertion. All specimens were CT imaged following insertion of all screws. A senior radiologist evaluated all scans and determined that a misplaced screw was a breach of ≥2 mm. A total of 104 drillings were performed, 52 with DSG and 52 without DSG There were 68 total pedicle drillings, 34 in each group. There were 18 drillings in the lamina and lateral mass. There was no significant difference between surgeons or between the left and right side. All breaches were in the pedicle, and none in the lamina or lateral mass. The breach rate for PG "on" was 6/68 = 8.96% (95% CI 3.69, 19.12%). The breach rate for PG "off" was 20/68 = 29.41% (95% CI 19.30, 41.87%). Of the 20 pedicle breaches in the non-DSG group, 7 were lateral and superior, 8 were lateral, 4 medial and 1 inferior. Of the six pedicle breaches in the DSG group, two were lateral/superior, two were lateral and two were medial in the pedicle. The dynamic surgical guidance probe is a safe tool to assist the surgeon with screw placement in the cervical spine. Additionally, the DSG potentially avoids the cumulative risks associated with fluoroscopy and provides real-time feedback to the surgeon allowing correction at the time of breach. Level of evidence Level IV.

Hollow screw-like drill in plasma using an intense Laguerre-Gaussian laser

NASA Astrophysics Data System (ADS)

Wang, Wenpeng; Shen, Baifei; Zhang, Xiaomei; Zhang, Lingang; Shi, Yin; Xu, Zhizhan

2015-02-01

With the development of ultra-intense laser technology, MeV ions can be obtained from laser-foil interactions in the laboratory. These energetic ion beams can be applied in fast ignition for inertial confinement fusion, medical therapy, and proton imaging. However, these ions are mainly accelerated in the laser propagation direction. Ion acceleration in an azimuthal orientation was scarcely studied. In this research, a doughnut Laguerre-Gaussian (LG) laser is used for the first time to examine laser-plasma interaction in the relativistic intensity regime in three-dimensional particle-in-cell simulations. Studies have shown that a novel rotation of the plasma is produced from the hollow screw-like drill of an mode laser. The angular momentum of particles in the longitudinal direction produced by the LG laser is enhanced compared with that produced by the usual laser pulses, such as linearly and circularly polarized Gaussian pulses. Moreover, the particles (including electrons and ions) can be trapped and uniformly compressed in the dark central minimum of the doughnut LG pulse. The hollow-structured LG laser has potential applications in the generation of x-rays with orbital angular momentum, plasma accelerators, fast ignition for inertial confinement fusion, and pulsars in the astrophysical environment.

Hollow screw-like drill in plasma using an intense Laguerre-Gaussian laser.

PubMed

Wang, Wenpeng; Shen, Baifei; Zhang, Xiaomei; Zhang, Lingang; Shi, Yin; Xu, Zhizhan

2015-02-05

With the development of ultra-intense laser technology, MeV ions can be obtained from laser-foil interactions in the laboratory. These energetic ion beams can be applied in fast ignition for inertial confinement fusion, medical therapy, and proton imaging. However, these ions are mainly accelerated in the laser propagation direction. Ion acceleration in an azimuthal orientation was scarcely studied. In this research, a doughnut Laguerre-Gaussian (LG) laser is used for the first time to examine laser-plasma interaction in the relativistic intensity regime in three-dimensional particle-in-cell simulations. Studies have shown that a novel rotation of the plasma is produced from the hollow screw-like drill of an mode laser. The angular momentum of particles in the longitudinal direction produced by the LG laser is enhanced compared with that produced by the usual laser pulses, such as linearly and circularly polarized Gaussian pulses. Moreover, the particles (including electrons and ions) can be trapped and uniformly compressed in the dark central minimum of the doughnut LG pulse. The hollow-structured LG laser has potential applications in the generation of x-rays with orbital angular momentum, plasma accelerators, fast ignition for inertial confinement fusion, and pulsars in the astrophysical environment.

Effects of abutment screw coating on implant preload.

PubMed

Park, Jae-Kyoung; Choi, Jin-Uk; Jeon, Young-Chan; Choi, Kyung-Soo; Jeong, Chang-Mo

2010-08-01

The aim of the present study was to investigate the effects of tungsten carbide carbon (WC/CTa) screw surface coating on abutment screw preload in three implant connection systems in comparison to noncoated titanium alloy (Ta) screws. Preload of WC/CTa abutment screws was compared to noncoated Ta screws in three implant connection systems. The differences in preloads were measured in tightening rotational angle, compression force, initial screw removal torque, and postload screw removal torque after 1 million cyclic loads. Preload loss percent was calculated to determine the efficacy of maintaining the preload of two abutment screw types in relation to implant connection systems. WC/CTa screws provided 10 degrees higher tightening rotational angle than Ta screws in all three connection systems. This difference was statistically significant (p < 0.05). External-hex butt joint implant connections had a higher compression force than the two internal conical implant connections. WC/CTa screws provided a statistically significantly higher compression force than Ta screws in all three implant connections (p < 0.05). Ta screws required statistically higher removal torque than WC/CTa screws in all three implant connections (p < 0.05); however, Ta screws needed statistically lower postload removal torque than WC/CTa screws in all three implant connections (p < 0.05). Ta screws had a statistically higher preload loss percent than WC/CTa screws in all three implant connections (p < 0.05), indicating that WC/CTa screws were superior in maintaining the preload than Ta screws. Within the limits of present study, the following conclusions were made: (1) WC/CTa screws provided higher preload than noncoated Ta screws in all three implant connection systems. (2) The initial removal torque for Ta screws required higher force than WC/CTa screws, whereas postload removal torque for Ta screws was lower than WC/CTa screws. Calculated Ta screw preload loss percent was higher than for WC/CTa screws, suggesting that WC/CTa screws were more effective in maintaining the preload than Ta screws. (3) Internal conical connections were more effective in maintaining the screw preload in cyclic loads than external-hex butt joint connections.

CLINICAL APPLICATION OF A DRILL GUIDE TEMPLATE FOR PEDICLE SCREW PLACEMENT IN SEVERE SCOLIOSIS.

PubMed

Li, Xin; Zhang, Yaoshen; Zhang, Qiang; Zhao, Changsong; Liu, Kun

2017-01-01

To evaluate the accuracy and the effect of drill guide template for pedicle screw placement in severe scoliosis. Eight patients with rigid scoliosis were enrolled, five males and three females, ranging from nine to 23 years old. A three-dimensional CT scan of the spine was performed and saved as a DICOM file type. The multi-level template was designed by Mimics software and manufactured according to the part of the most severe deformity. The drill template was placed on the corresponding vertebral surface. Pedicle screws were carefully inserted across the trajectory of the template. Postoperatively, the positions of the pedicle screws were evaluated by CT scan and graded for validation. No spinal cord injury or nerve damage occurred. All patients had satisfactory outcomes. The abnormalities and the measures observed during operation were the same as those found in the preoperative period. The position of the pedicle screws was accurate, according to the postoperative X-ray and CT scan. The rate of scoliosis correction was 60%. Compared with controls, surgery time, blood loss and radiation were significantly lower. With the application of multi-level template, the placement of pedicle screws shows high accuracy in scoliosis with shorter surgical time, less blood loss and less radiation exposure. Level of Evidence III, Retrospective Comparative Study.

Study of Bulk and Elementary Screw Dislocation Assisted Reverse Breakdown in Low-Voltage (less than 250 V) 4H-SiC p(+)n Junction diodes. Part 1; DC Properties

NASA Technical Reports Server (NTRS)

Neudeck, Philip G.; Huang, Wei; Dudley, Michael

1998-01-01

Given the high density (approx. 10(exp 4)/sq cm) of elementary screw dislocations (Burgers vector = 1c with no hollow core) in commercial SiC wafers and epilayers, all appreciable current (greater than 1 A) SiC power devices will likely contain elementary screw dislocations for the foreseeable future. It is therefore important to ascertain the electrical impact of these defects, particularly in high-field vertical power device topologies where SiC is expected to enable large performance improvements in solid-state high-power systems. This paper compares the DC-measured reverse-breakdown characteristics of low-voltage (less than 250 V) small-area (less than 5 x 10(exp -4)/sq cm) 4H-SiC p(+)n diodes with and without elementary screw dislocations. Compared to screw dislocation-free devices, diodes containing elementary screw dislocations exhibited higher pre-breakdown reverse leakage currents, softer reverse breakdown I-V knees, and highly localized microplasmic breakdown current filaments. The observed localized 4H-SiC breakdown parallels microplasmic breakdowns observed in silicon and other semiconductors, in which space-charge effects limit current conduction through the local microplasma as reverse bias is increased.

Study of Bulk and Elementary Screw Dislocation Assisted Reverse Breakdown in Low-Voltage (<250 V) 4H-SiC p+n Junction Diodes - Part 1: DC Properties

NASA Technical Reports Server (NTRS)

Neudeck, Philip G.; Huang, Wei; Dudley, Michael

1999-01-01

Given the high density (approx. 10(exp 4)/sq cm) of elementary screw dislocations (Burgers vector = lc with no hollow core) in commercial SiC wafers and epilayers, all appreciable current (greater than 1 A) SiC power devices will likely contain elementary screw dislocations for the foreseeable future. It is therefore important to ascertain the electrical impact of these defects, particularly in high-field vertical power device topologies where SiC is expected to enable large performance improvements in solid-state high-power systems. This paper compares the DC-measured reverse-breakdown characteristics of low-voltage (less than 250 V) small-area (less than 5 x 10(exp -4) sq cm) 4H-SiC p(+)n diodes with and without elementary screw dislocations. Compared to screw dislocation-free devices, diodes containing elementary screw dislocations exhibited higher pre-breakdown reverse leakage currents, softer reverse breakdown I-V knees, and highly localized microplasmic breakdown current filaments. The observed localized 4H-SiC breakdown parallels microplasmic breakdowns observed in silicon and other semiconductors, in which space-charge effects limit current conduction through the local microplasma as reverse bias is increased.

Note: High-speed Z tip scanner with screw cantilever holding mechanism for atomic-resolution atomic force microscopy in liquid

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reza Akrami, Seyed Mohammad; Miyata, Kazuki; Asakawa, Hitoshi

High-speed atomic force microscopy has attracted much attention due to its unique capability of visualizing nanoscale dynamic processes at a solid/liquid interface. However, its usability and resolution have yet to be improved. As one of the solutions for this issue, here we present a design of a high-speed Z-tip scanner with screw holding mechanism. We perform detailed comparison between designs with different actuator size and screw arrangement by finite element analysis. Based on the design giving the best performance, we have developed a Z tip scanner and measured its performance. The measured frequency response of the scanner shows a flatmore » response up to ∼10 kHz. This high frequency response allows us to achieve wideband tip-sample distance regulation. We demonstrate the applicability of the scanner to high-speed atomic-resolution imaging by visualizing atomic-scale calcite crystal dissolution process in water at 2 s/frame.« less

Novel deformable mirror design for possible wavefront correction in CO2 laser fusion system

NASA Astrophysics Data System (ADS)

Gunn, S. V.; Heinz, T. A.; Henderson, W. D.; Massie, N. A.; Viswanathan, V. K.

1980-11-01

Analysis at Los Alamos and elsewhere has resulted in the conclusion that deformable mirrors can substantially improve the optical performance of laser fusion systems, as the errors are mostly static or quasi-static with mainly low spatial frequencies across the aperture resulting in low order Seidel aberrations in the beam. A novel deformable mirror assembly (Fig. 1) has been fabricated with 19 actuators capable of surface deflection of ±20 microns. The mirror surface deflections are produced by a unique differential ball screw that acts as both a force and position actuator. The screw is driven by a stepper motor giving a surface positioning resolution of 0.025 micron. No holding voltage potential is required, and a piezoceramic element in series with each ball screw provides a ±1 micron amplitude high-frequency surface dither to aid the correction process. Mirror performance in terms of individual actuator influence function, cross-coupling, figure attainment, long-term surface stability as well as optical performance characteristics will be discussed.

Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

PubMed Central

Belthur, Mohan V.; Paley, Dror; Jindal, Gaurav; Burghardt, Rolf D.; Specht, Stacy C.

2008-01-01

Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and hypochondroplasia (one). Average age was 24.5 years (range, 15–54 years). The screw (length, typically 125 mm; diameter, 7 mm) was inserted with the ankle in 10° dorsiflexion. Gastrocnemius soleus recession was performed in two patients to achieve 10° dorsiflexion. Average lengthening was 4.9 cm (range, 3–7 cm). Screws were removed after a mean 3.3 months (range, 2–6 months). Preoperative ankle range of motion was regained within 6 months of screw removal. No neurovascular complications were encountered, and no patients experienced equinus contracture. We also conducted a cadaveric study in which one surgeon inserted screws in eight cadaveric legs under image intensifier control. The flexor hallucis longus muscle belly was the closest anatomic structure noted during dissection. The screw should be inserted obliquely from upper lateral edge of the calcaneus and aimed lateral in the tibia to avoid the flexor hallucis longus muscle. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18800215

Tightening force and torque of nonlocking screws in a reverse shoulder prosthesis.

PubMed

Terrier, A; Kochbeck, S H; Merlini, F; Gortchacow, M; Pioletti, D P; Farron, A

2010-07-01

Reversed shoulder arthroplasty is an accepted treatment for glenohumeral arthritis associated to rotator cuff deficiency. For most reversed shoulder prostheses, the baseplate of the glenoid component is uncemented and its primary stability is provided by a central peg and peripheral screws. Because of the importance of the primary stability for a good osteo-integration of the baseplate, the optimal fixation of the screws is crucial. In particular, the amplitude of the tightening force of the nonlocking screws is clearly associated to this stability. Since this force is unknown, it is currently not accounted for in experimental or numerical analyses. Thus, the primary goal of this work is to measure this tightening force experimentally. In addition, the tightening torque was also measured, to estimate an optimal surgical value. An experimental setup with an instrumented baseplate was developed to measure simultaneously the tightening force, tightening torque and screwing angle, of the nonlocking screws of the Aquealis reversed prosthesis. In addition, the amount of bone volume around each screw was measured with a micro-CT. Measurements were performed on 6 human cadaveric scapulae. A statistically correlated relationship (p<0.05, R=0.83) was obtained between the maximal tightening force and the bone volume. The relationship between the tightening torque and the bone volume was not statistically significant. The experimental relationship presented in this paper can be used in numerical analyses to improve the baseplate fixation in the glenoid bone. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Mechanics of the taper integrated screwed-in (TIS) abutments used in dental implants.

PubMed

Bozkaya, Dinçer; Müftü, Sinan

2005-01-01

The tapered implant-abutment interface is becoming more popular due to the mechanical reliability of retention it provides. Consequently, understanding the mechanical properties of the tapered interface with or without a screw at the bottom has been the subject of a considerable amount of studies involving experiments and finite element (FE) analysis. This paper focuses on the tapered implant-abutment interface with a screw integrated at the bottom of the abutment. The tightening and loosening torques are the main factors in determining the reliability and the stability of the attachment. Analytical formulas are developed to predict tightening and loosening torque values by combining the equations related to the tapered interface with screw mechanics equations. This enables the identification of the effects of the parameters such as friction, geometric properties of the screw, the taper angle, and the elastic properties of the materials on the mechanics of the system. In particular, a relation between the tightening torque and the screw pretension is identified. It was shown that the loosening torque is smaller than the tightening torque for typical values of the parameters. Most of the tightening load is carried by the tapered section of the abutment, and in certain combinations of the parameters the pretension in the screw may become zero. The calculations performed to determine the loosening torque as a percentage of tightening torque resulted in the range 85-137%, depending on the values of taper angle and the friction coefficient.

Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients.

PubMed

Anderson, Richard C E; Ragel, Brian T; Mocco, J; Bohman, Leif-Erik; Brockmeyer, Douglas L

2007-07-01

Atlantoaxial and occipitocervical instability in children have traditionally been treated with posterior bone and wire fusion and external halo orthoses. Recently, successful outcomes have been achieved using rigid internal fixation, particularly C1-2 transarticular screws. The authors describe flow diagrams created to help clinicians determine which method of internal fixation to use in complex anatomical circumstances when bilateral transarticular screw placement is not possible. The records of children who underwent either atlantoaxial or occipitocervical fixation with rigid internal fixation over an 11-year period were retrospectively reviewed to define flow diagrams used to determine treatment protocols. Among the 95 patients identified who underwent atlantoaxial or occipitocervical fixation, the craniocervical anatomy in 25 patients (six atlantoaxial and 19 occipitocervical fixations [26%]) required alternative methods of internal fixation. Types of screw fixation included loop or rod constructs anchored by combinations of C1-2 transarticular screws (15 constructs), C-1 lateral mass screws (11), C-2 pars screws (24), C-2 translaminar screws (one), and subaxial lateral mass screws (six). The mean age of the patients (15 boys and 10 girls) was 9.8 years (range 1.3-17 years). All 22 patients with greater than 3-month follow-up duration achieved solid bone fusion and maintained stable constructs on radiographic studies. Clinical improvement was seen in all patients who had preoperative symptoms. Novel flow diagrams are suggested to help guide selection of rigid internal fixation constructs when performing pediatric C1-2 and occipitocervical stabilizations. Use of these flow diagrams has led to successful fusion in 25 pediatric patients with difficult anatomy requiring less common constructs.

Unskilled unawareness and the learning curve in robotic spine surgery.

PubMed

Schatlo, Bawarjan; Martinez, Ramon; Alaid, Awad; von Eckardstein, Kajetan; Akhavan-Sigari, Reza; Hahn, Anina; Stockhammer, Florian; Rohde, Veit

2015-10-01

Robotic assistance for the placement of pedicle screws has been established as a safe technique. Nonetheless rare instances of screw misplacement have been reported.The aim of the present retrospective study is to assess whether experience and time affect the accuracy of screws placed with the help of the SpineAssist™ robot system. Postoperative computed tomography (CT) scans of 258 patients requiring thoracolumbar pedicle screw instrumentation from 2008 to 2013 were reviewed. Overall, 13 surgeons performed the surgeries. A pedicle breach of >3 mm was graded as a misplacement. Surgeons were dichotomised into an early and experienced period in increments of five surgeries. In 258 surgeries, 1,265 pedicle screws were placed with the aid of the robot system. Overall, 1,217 screws (96.2 %) were graded as acceptable. When displayed by surgeon, the development of percent misplacement rates peaked between 5 and 25 surgeries in 12 of 13 surgeons. The overall misplacement rate in the first five surgeries was 2.4 % (6/245). The misplacement rate rose to 6.3 % between 11 and 15 surgeries (10/158; p = 0.20), and reached a significant peak between 16 and 20 surgeries with a rate of 7.1 % (8/112; p = 0.03). Afterwards, misplacement rates declined. A major peak in screw inaccuracies occurred between cases 10 and 20, and a second, smaller one at about 40 surgeries. One potential explanation could be a transition from decreased supervision (unskilled but aware) to increased confidence of a surgeon (unskilled but unaware) who adopts this new technique prior to mastering it (skilled). We therefore advocate ensuring competent supervision for new surgeons at least during the first 25 procedures of robotic spine surgery to optimise the accuracy of robot-assisted pedicle screws.

Metal artifacts reduction using monochromatic images from spectral CT: evaluation of pedicle screws in patients with scoliosis.

PubMed

Wang, Yang; Qian, Bangping; Li, Baoxin; Qin, Guochu; Zhou, Zhengyang; Qiu, Yong; Sun, Xizhao; Zhu, Bin

2013-08-01

To evaluate the effectiveness of spectral CT in reducing metal artifacts caused by pedicle screws in patients with scoliosis. Institutional review committee approval and written informed consents from patients were obtained. 18 scoliotic patients with a total of 228 pedicle screws who underwent spectral CT imaging were included in this study. Monochromatic image sets with and without the additional metal artifacts reduction software (MARS) correction were generated with photon energy at 65keV and from 70 to 140keV with 10keV interval using the 80kVp and 140kVp projection sets. Polychromatic images corresponded to the conventional 140kVp imaging were also generated from the same scan data as a control group. Both objective evaluation (screw width and quantitative artifacts index measurements) and subjective evaluation (depiction of pedicle screws, surrounding structures and their relationship) were performed. Image quality of monochromatic images in the range from 110 to 140keV (0.97±0.28) was rated superior to the conventional polychromatic images (2.53±0.54) and also better than monochromatic images with lower energy. Images of energy above 100keV also give accurate measurement of the width of screws and relatively low artifacts index. The form of screws was slightly distorted in MARS reconstruction. Compared to conventional polychromatic images, monochromatic images acquired from dual-energy CT provided superior image quality with much reduced metal artifacts of pedicle screws in patients with scoliosis. Optimal energy range was found between 110 and 140keV. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.

PubMed

Farber, Scott J; Snyder-Warwick, Alison K; Skolnick, Gary B; Woo, Albert S; Patel, Kamlesh B

2016-09-01

Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.

Biomechanical Analysis of Suture Anchor vs Tenodesis Screw for FHL Transfer.

PubMed

Drakos, Mark C; Gott, Michael; Karnovsky, Sydney C; Murphy, Conor I; DeSandis, Bridget A; Chinitz, Noah; Grande, Daniel; Chahine, Nadeen

2017-07-01

Chronic Achilles injury is often treated with flexor hallucis longus (FHL) tendon transfer to the calcaneus using 1 or 2 incisions. A single incision avoids the risks of extended dissections yet yields smaller grafts, which may limit fixation options. We investigated the required length of FHL autograft and biomechanical profiles for suture anchor and biotenodesis screw fixation. Single-incision FHL transfer with suture anchor or biotenodesis screw fixation to the calcaneus was performed on 20 fresh cadaveric specimens. Specimens were cyclically loaded until maximal load to failure. Length of FHL tendon harvest, ultimate load, stiffness, and mode of failure were recorded. Tendon harvest length needed for suture anchor fixation was 16.8 ± 2.1 mm vs 29.6 ± 2.4 mm for biotenodesis screw ( P = .002). Ultimate load to failure was not significantly different between groups. A significant inverse correlation existed between failure load and donor age when all specimens were pooled (ρ = -0.49, P < .05). Screws in younger specimens (fewer than 70) resulted in significantly greater failure loads ( P < .03). No difference in stiffness was found between groups. Modes of failure for screw fixation were either tunnel pullout (n = 6) or tendon rupture (n = 4). Anchor failure occurred mostly by suture breakage (n = 8). Adequate FHL tendon length could be harvested through a single posterior incision for fixation to the calcaneus with either fixation option, but suture anchor required significantly less graft length. Stiffness, fixation strength, and load to failure were comparable between groups. An inverse correlation existed between failure load and donor age. Younger specimens with screw fixation demonstrated significantly greater failure loads. Adequate harvest length for FHL transfer could be achieved with a single posterior incision. There was no difference in strength of fixation between suture anchor and biotenodesis screw.

[The biomechanics of screws, cerclage wire and cerclage cable].

PubMed

Schröder, C; Woiczinski, M; Utzschneider, S; Kraxenberger, M; Weber, P; Jansson, V

2013-05-01

In contrast to fracture fixation, when performing an osteotomy the surgeon is able to plan preoperatively. The resulting fixation and compression of the bone fragments are the most important points. A stable osteosynthesis should prevent dislocation of bone fragments and improve bone healing. Beside plates, cerclages can be used for tension band or diaphysis bone fixation. Moreover, cortical or cancellous screws can be used for osteotomy fixation. This work describes biomechanical principles for fixation after an osteotomy with cerclages and cortical or cancellous screws. It also summarizes the materials and geometries used, as well as their influence on the stability of the osteosynthesis.

Design and analysis of a field modulated magnetic screw for artificial heart

NASA Astrophysics Data System (ADS)

Ling, Zhijian; Ji, Jinghua; Wang, Fangqun; Bian, Fangfang

2017-05-01

This paper proposes a new electromechanical energy conversion system, called Field Modulated Magnetic Screw (FMMS) as a high force density linear actuator for artificial heart. This device is based on the concept of magnetic screw and linear magnetic gear. The proposed FMMS consists of three parts with the outer and inner carrying the radially magnetized helically permanent-magnet (PM), and the intermediate having a set of helically ferromagnetic pole pieces, which modulate the magnetic fields produced by the PMs. The configuration of the newly designed FMMS is presented and its electromagnetic performances are analyzed by using the finite-element analysis, verifying the advantages of the proposed structure.

Load positioning system with gravity compensation

NASA Technical Reports Server (NTRS)

Hollow, R. H.

1984-01-01

A load positioning system with gravity compensation has a servomotor, position sensing feedback potentiometer and velocity sensing tachometer in a conventional closed loop servo arrangement to cause a lead screw and a ball nut to vertically position a load. Gravity compensating components comprise the DC motor, gears, which couple torque from the motor to the lead screw, and constant current power supply. The constant weight of the load applied to the lead screw via the ball nut tend to cause the lead screw to rotate, the constant torque of which is opposed by the constant torque produced by the motor when fed from the constant current source. The constant current is preset as required by the potentiometer to effect equilibration of the load which thereby enables the positioning servomotor to see the load as weightless under both static and dynamic conditions. Positioning acceleration and velocity performance are therefore symmetrical.

De-pulping and Seed Separation from Tumba ( Citrullus colocynthis) Fruit

NASA Astrophysics Data System (ADS)

Mudgal, Vishvambhar Dayal

2017-09-01

Tumba ( Citrullus colocynthis) contains spongy pulp in which seeds are embedded unevenly. Seeds contain about 26% fats and 13% protein. The process of seed separation is highly time consuming and labour intensive. Two weeks are required to separate its seeds with traditional methods. The developed prototype, for separating tumba seeds, mainly consists of chopper, de-pulping screw, barrel assembly and seed separation unit. The de-pulping screw and barrel assembly was divided in two sections i.e. conveying (feeding zone) and compression sections (de-pulping zone). The performance of developed machine was evaluated at different screw speed in the range of 40-100 rpm. Maximum pulp removal efficiency of 78.1% was achieved with screw speed of 60 rpm. Seed separation from the pulp was carried out by adding different chemicals. Use of sodium hydroxide and potassium hydroxide produced seed separation up to 99%.

[SCREW-BASED INTERMAXILLARY TRACTION COMBINED WITH OCCLUSAL SPLINT FOR TREATMENT OF PEDIATRIC MANDIBULAR CONDYLAR FRACTURE].

PubMed

Wu, Yang; Long, Xing; Deng, Mohong; Cai, Hengxing; Meng, Qinggong; Li, Bo

2015-04-01

To evaluate the effectiveness of the screw-based intermaxillary traction combined with occlusal splint in the treatment of pediatric mandibular condylar fracture. Between June 2005 and December 2013, 35 pediatric patients with 49 mandibular condylar fractures were treated, and the clinical data were retrospectively reviewed. There were 25 boys and 10 girls, aged 3-13 years (mean, 7.3 years). The injury causes included falling (18 cases), traffic accident (14 cases), and violence (3 cases). The time between injury and treatment was 2-30 days (mean, 6.8 days). Restricted mouth opening was observed, and the maximal mouth opening was (22.74 +/- 7.22) mm except 3 patients who were too young to measure. Condylar fractures were located at the left (12 cases), at the right (9 cases), at bilateral (14 cases) based on the sites; and fractures were classified as intracapsular (35 fractures), neck (10 fractures), and subcondylar (4 fractures) based on the fracture line. Four self-drilling titanium screws were inserted into the alveolar bone of both maxilla and mandible. After screw inserting, an occlusal splint with a fulcrum was used on the affected side and elastic band was put to perform anterior intermaxillary traction. After 1 month, the screws and splint were removed. Follow-up examinations were carried out on schedule. All the patients were followed up from 6 months to 8 years and 10 months (median, 71 months). No screw-related complication occurred in the others except one case of screw loosening. The postoperative maximal mouth opening was (38.82 +/- 2.02) nim. Mild joint noise was found in 4 cases and opening deviation occurred in 6 cases. Radiographic results demonstrated complete condyle remodeling was achieved in 24 cases (32 fractures), and moderate remodeling in 11 cases (17 fractures) at last follow-up. The screw-based intermaxillary traction combined with occlusal splint might be an effective method for pediatric mandibular condylar fracture. The screw-related complications may be avoided by careful preoperative investigations.

Adjacent-segment disease after thoracic pedicle screw fixation.

PubMed

Agarwal, Nitin; Heary, Robert F; Agarwal, Prateek

2018-03-01

OBJECTIVE Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

Treatment of Lateral Tibial Condylar Fractures Using Bioactive, Bioresorbable Forged Composites of Raw Particulate Unsintered Hydroxyapatite/Poly-L-Lactide Screws.

PubMed

Kuroyanagi, Gen; Yoshihara, Hiroyuki; Yamamoto, Naohiro; Suzuki, Hiroyuki; Yamada, Kunio; Yoshida, Yukio; Otsuka, Takanobu; Takada, Naoya

2018-05-01

Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) devices possess high mechanical strength, bioactivity, and radio-opacity. The aim of this study was to assess the efficacy of F-u-HA/PLLA screws in the treatment of lateral tibial condylar fractures. From January 2005 to December 2010, a total of 7 patients with displaced closed lateral tibial condylar fractures (Schatzker type II) were treated using F-u-HA/PLLA screws. Open reduction and internal fixation was performed using 2 or 3 F-u-HA/PLLA screws. After surgery, weight bearing was not allowed for 6 weeks. Range of motion exercise was initiated after removal of the plaster splint. Radiographs were evaluated for fracture healing, joint depression, and the radioopacity of F-u-HA/PLLA screws. Clinical outcomes and postoperative complications were also assessed. Average follow-up was 44 months. All fractures were successfully healed. Average values for joint depression were 4.7 mm (range, 2-9 mm) preoperatively, 0.4 mm (range, 0-1 mm) postoperatively, and 0.4 mm (range, 0-1 mm) at final follow-up. Whole shadows of F-u-HA/PLLA screws were observed during the follow-up period. Breakage of screws, osteolysis, and a radiolucent zone around the screws were not observed at final follow-up. Average knee flexion and extension were 134° (range, 110° to 150°) and -1° (range, -10° to 0°), respectively. No patient had wound infection, late aseptic tissue response, or foreign body reaction postoperatively. None of the patients reported pain at final follow-up. These results suggest that F-u-HA/PLLA screws could be an alternative option for the treatment of lateral tibial condylar fractures. [Orthopedics. 2018; 41(3):e365-e368.]. Copyright 2018, SLACK Incorporated.

Exploring the role of 3-dimensional simulation in surgical training: feedback from a pilot study.

PubMed

Podolsky, Dale J; Martin, Allan R; Whyne, Cari M; Massicotte, Eric M; Hardisty, Michael R; Ginsberg, Howard J

2010-12-01

Randomized control study assessing the efficacy of a pedicle screw insertion simulator. To evaluate the efficacy of an in-house developed 3-dimensional software simulation tool for teaching pedicle screw insertion, to gather feedback about the utility of the simulator, and to help identify the context and role such simulation has in surgical education. Traditional instruction for pedicle screw insertion technique consists of didactic teaching and limited hands-on training on artificial or cadaveric models before guided supervision within the operating room. Three-dimensional computer simulation can provide a valuable tool for practicing challenging surgical procedures; however, its potential lies in its effective integration into student learning. Surgical residents were recruited from 2 sequential years of a spine surgery course. Patient and control groups both received standard training on pedicle screw insertion. The patient group received an additional 1-hour session of training on the simulator using a CT-based 3-dimensional model of their assigned cadaver's spine. Qualitative feedback about the simulator was gathered from the trainees, fellows, and staff surgeons, and all pedicles screws physically inserted into the cadavers during the courses were evaluated through CT. A total of 185 thoracic and lumbar pedicle screws were inserted by 37 trainees. Eighty-two percent of the 28 trainees who responded to the questionnaire and all fellows and staff surgeons felt the simulator to be a beneficial educational tool. However, the 1-hour training session did not yield improved performance in screw placement. A 3-dimensional computer-based simulation for pedicle screw insertion was integrated into a cadaveric spine surgery instructional course. Overall, the tool was positively regarded by the trainees, fellows, and staff surgeons. However, the limited training with the simulator did not translate into widespread comfort with its operation or into improvement in physical screw placement.

Stability of the prosthetic screws of three types of craniofacial prostheses retention systems

PubMed Central

2016-01-01

Objectives This study aimed to evaluate the stability of prosthetic screws from three types of craniofacial prostheses retention systems (bar-clip, ball/O-ring, and magnet) when submitted to mechanical cycling. Materials and Methods Twelve models of acrylic resin were used with implants placed 20 mm from each other and separated into three groups: (1) bar-clip (Sistema INP, São Paulo, Brazil), (2) ball/O-ring (Sistema INP), and (3) magnet (Metalmag, São Paulo, Brazil), with four samples in each group. Each sample underwent a mechanical cycling removal and insertion test (f=0.5 Hz) to determine the torque and the detorque values of the retention screws. A servo-hydraulic MTS machine (810-Flextest 40; MTS Systems, Eden Prairie, MN, USA) was used to perform the cycling with 2.5 mm and a displacement of 10 mm/s. The screws of the retention systems received an initial torque of 30 Ncm and the torque values required for loosening the screw values were obtained in three cycles (1,080, 2,160, and 3,240). The screws were retorqued to 30 Ncm before each new cycle. Results The sample was composed of 24 screws grouped as follows: bar-clip (n=8), ball/O-ring (n=8), and magnet (n=8). There were significant differences between the groups, with greater detorque values observed in the ball/O-ring group when compared to the bar-clip and magnet groups for the first cycle. However, the detorque value was greater in the bar-clip group for the second cycle. Conclusion The results of this study indicate that all prosthetic screws will loosen slightly after an initial tightening torque, also the bar-clip retention system demonstrated greater loosening of the screws when compared with ball/O-ring and magnet retention systems. PMID:28053905

Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis.

PubMed

Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf

2017-03-01

Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

Improving socket design to prevent difficult removal of locking screws.

PubMed

Lin, Chen-Huei; Chao, Ching-Kong; Tang, Yi-Hsuan; Lin, Jinn

2018-03-01

Reports of driver slippage leading to difficult locking screw removals have increased since the adoption of titanium for screw fabrication; the use of titanium is known to cause cross-threading and cold welding. Such problems occur most frequently in screws with hex sockets, and may cause serious surgical complications. This study aimed to improve screw socket design to prevent slippage and difficult screw removal. Three types of small sockets (hex, Torx, and cruciate) and six types of large sockets (hex, Torx, Octatorx, Torx+ I, Torx+ II, and Torx+ III) with screw head diameters of 5.5 mm were manufactured from titanium, and corresponding screwdrivers were manufactured from stainless steel. The screw heads and drivers were mounted on a material testing machine, and torsional tests were conducted to simulate screw usage in clinical settings at two insertion depths: 1 and 2 mm. Ten specimens were tested from each design, and the maximum torque and failure patterns were recorded and compared. For small sockets in 2 mm conditions, the hex with the largest driver core had the highest torque, followed by Torx and cruciate. In these tests, the drivers were twisted off in all specimens. However, under the 1 mm condition, the hex slipped and the torque decreased markedly. Overall, torque was higher for large sockets than for small sockets. The Octatorx, with a large core and simultaneous deformation of the driver and socket lobes, had the highest torque at almost twice that of the small hex. The hex had the lowest torque, a result of slippage in both the 1 and 2 mm conditions. Torx plus designs, with more designed degrees of freedom, were able to maintain a higher driving angle and larger core for higher torque. The hex design showed slipping tendencies with a marked decrease in torque, especially under conditions with inadequate driver engagement. Large sockets allowed for substantial increases in torque. The Torx, Octatorx, and Torx plus designs displayed better performance than the hexes. Improvements to the socket design could effectively prevent slippage and solve difficult screw removal problems. Copyright © 2018. Published by Elsevier Ltd.

Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training.

PubMed

Park, Hyun Jin; Wang, Chenyu; Choi, Kyung Ho; Kim, Hyong Nyun

2018-04-16

Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure. Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect. A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2-3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p < 0.001). The mean length of time to complete 10 pedicle screw instrumentations in a spine model was 42.8 ± 5.3 min for the former 10 spine models and 35.6 ± 2.9 min for the latter 10 spine models. The latter 10 spine models had significantly less time than the former 10 models (p < 0.001). A life-size 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation.

Reciprocating and Screw Compressor semi-empirical models for establishing minimum energy performance standards

NASA Astrophysics Data System (ADS)

Javed, Hassan; Armstrong, Peter

2015-08-01

The efficiency bar for a Minimum Equipment Performance Standard (MEPS) generally aims to minimize energy consumption and life cycle cost of a given chiller type and size category serving a typical load profile. Compressor type has a significant chiller performance impact. Performance of screw and reciprocating compressors is expressed in terms of pressure ratio and speed for a given refrigerant and suction density. Isentropic efficiency for a screw compressor is strongly affected by under- and over-compression (UOC) processes. The theoretical simple physical UOC model involves a compressor-specific (but sometimes unknown) volume index parameter and the real gas properties of the refrigerant used. Isentropic efficiency is estimated by the UOC model and a bi-cubic, used to account for flow, friction and electrical losses. The unknown volume index, a smoothing parameter (to flatten the UOC model peak) and bi-cubic coefficients are identified by curve fitting to minimize an appropriate residual norm. Chiller performance maps are produced for each compressor type by selecting optimized sub-cooling and condenser fan speed options in a generic component-based chiller model. SEER is the sum of hourly load (from a typical building in the climate of interest) and specific power for the same hourly conditions. An empirical UAE cooling load model, scalable to any equipment capacity, is used to establish proposed UAE MEPS. Annual electricity use and cost, determined from SEER and annual cooling load, and chiller component cost data are used to find optimal chiller designs and perform life-cycle cost comparison between screw and reciprocating compressor-based chillers. This process may be applied to any climate/load model in order to establish optimized MEPS for any country and/or region.

Low-Dose Radiation 3D Intraoperative Imaging: How Low Can We Go? An O-Arm, CT Scan, Cadaveric Study.

PubMed

Sarwahi, Vishal; Payares, Monica; Wendolowski, Stephen; Maguire, Kathleen; Thornhill, Beverly; Lo, Yungtai; Amaral, Terry D

2017-11-15

MINI: The objective of this study was to evaluate the accuracy and reliability of pedicle screw placement using O-Arm at dosages below the manufactured recommended dose. O-Arm at reduced dose showed a 90% accuracy when compared with computed tomography; however, about 30% medial breaches were misclassified. Cadaveric study. The objective was to evaluate O-Arm's ability at low-dose (LD) settings to assess intraoperative screw placement. Accurate placement of pedicle screws is crucial because of proximity to vital structures. Malposition of screws may result in significant morbidity and potential mortality. O-arm provides real-time, intraoperative imaging of patient's anatomy and provides higher accuracy in scoliosis surgeries, avoiding risk to vital structures. We hypothesize using LD or ultra-low doses (ULDs) to obtain intraoperative images allow for accurate assessment of screw placement, both minimizing radiation exposure and preventing screw misplacement. Eight cadavers were instrumented with pedicle screws bilaterally from T1 to S1. Screws were randomly placed using O-arm navigation into three positions: contained within the bone, OUT-anterior/lateral, and OUT-medial. O-arm images were obtained at three dosage settings: LD (kVp120/mAs125-lowest manufacturer recommended), very-low dose (VLD) (kVp120/mAs63), and ULD (kVp120/mAs39). Computed tomography (CT) scan was performed using institution's LD protocol (kVp100/mAs50) and gross dissection to identify screw positions. LD, VLD, ULD, and CT for identifying "IN" screws relative to gross dissection had, a mean (standard deviation) sensitivity of 84.2% (±5.7), specificity of 76.1% (±9.3), and accuracy of 79.9% (±3.1) from all three observers. Across the three observers, the interobserver agreement was 0.67 (0.61-0.72) for LD, 0.74 (0.69-0.79) for VLD, 0.61 (0.56-0.66) for ULD, and 0.79 (0.74-0.84) for CT. Effective doses of radiation (mSV) for LD O-arm scan was 2.16, VLD 1.08, ULD 0.68, and our LD CT protocol was 1.05. Accuracy of pedicle screw placement is similar for O-arm at all doses and CT compared to gross dissection. Interobserver reliability was substantial for VLD and CT. Approximately 30% of medial screw breaches are, however, misclassified. ULD and VLDs can be used for intraoperative navigation and evaluation purposes within these limitations. N/A.

Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up.

PubMed

Deen, H Gordon; Birch, Barry D; Wharen, Robert E; Reimer, Ronald

2003-01-01

Lateral mass plating has become the technique of choice for posterior cervical fixation. Although these systems are safe and reliable, they can be difficult to use in patients with abnormal cervical anatomy; screw placement can be compromised by the fixed hole spacing of the plate; screw back-out and other forms of implant failure can occur; and extension across the cervicothoracic junction can be problematic. To report a series of patients undergoing posterior cervical stabilization with a polyaxial screw-rod construct and to investigate whether this new system offers any advantages over existing methods of fixation. A prospective study evaluating clinical and radiographic parameters in a consecutive series of patients treated with this technique. There were 21 patients in the study group. The surgical indication was cervical spondylosis in 14, trauma in 2, postsurgical kyphosis in 2 and 1 case each of congenital cervicothoracic stenosis, C7-T1 pseudarthrosis and basilar invagination with brainstem compression. Clinical indicators included age, gender, neurologic status, surgical indication and number of levels stabilized. Note was made of whether laminectomy and concomitant anterior reconstructive surgery were performed. Radiographic indicators included early postoperative computed tomography (CT) scan to check for screw placement and plain radiographs at subsequent visits. The participants in this study underwent posterior cervical stabilization using lateral mass screw-rod fixation. Clinical and radiographic assessment was carried out immediately after surgery, and 3, 6 and 12 months after surgery. One-year follow-up was obtained in all cases. A total of 212 screws were implanted in 21 patients. Fixation was carried out over an average of 5.5 spinal segments (range, 2 to 11). The system was successfully implanted in all patients despite the presence of coronal and sagittal plane deformities and/or lateral mass abnormalities in the majority of cases. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-C7 lateral masses and upper thoracic pedicles. Early postoperative CT scanning confirmed satisfactory screw placement in all cases. Three patients experienced transient single-level radiculopathy, for an incidence of 1.4% per screw placed. Two patients developed wound seromas requiring evacuation. There were no infections or other wound healing problems. There were no examples of cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, loss of alignment or implant failure. When compared with plating techniques, screw-rod fixation appeared to offer several advantages. First, unlike plates, rods proved to be amenable to multiplanar contouring, which is often needed for deformities associated with cervical spondylosis. Second, lateral mass screw placement was more precise because it was not constrained by the hole spacing of the plate. Third, screw back-out and other types of implant failure were not seen. Fourth, the screw-rod system was more easily extended to the occiput and across the cervicothoracic junction. Fifth, the screw-rod system permitted the application of compression, distraction and reduction forces within the construct, to a greater extent than plate systems. The incidence of postoperative radiculopathy was similar to that seen with plate systems. These data indicate that posterior cervical stabilization with polyaxial screw-rod fixation is a safe, straightforward technique that appears to offer some advantages over existing methods of fixation. Results appear to be durable at 1-year follow-up. Benefits are more significant with longer constructs, especially those extending to the occiput or crossing the cervicothoracic junction.

Comparison of calcaneal fixation of a retrograde intramedullary nail with a fixed-angle spiral blade versus a fixed-angle screw.

PubMed

Klos, Kajetan; Gueorguiev, Boyko; Schwieger, Karsten; Fröber, Rosemarie; Brodt, Steffen; Hofmann, Gunther O; Windolf, Markus; Mückley, Thomas

2009-12-01

Retrograde intramedullary nailing is an established technique for tibiotalocalcaneal arthrodesis (TTCA). In poor bone stock (osteoporosis, neuroarthropathy), device fixation in the hindfoot remains a problem. Fixed-angle spiral-blade fixation of the nail in the calcaneus could be useful. In seven matched pairs of human below-knee specimens, bone mineral density (BMD) was determined, and TTCA was performed with an intramedullary nail (Synthes Hindfoot Arthrodesis Nail HAN Expert Nailing System), using a conventional screw plus a fixed-angle spiral blade versus a conventional screw plus a fixed-angle screw, in the calcaneus. The constructs were subjected to quasi-static loading (dorsiflexion/plantarflexion, varus/valgus, rotation) and to cyclic loading to failure. Parameters studied were construct neutral zone (NZ) and range of motion (ROM), and number of cycles to failure. With dorsiflexion/plantarflexion loading, the screw-plus-spiral-blade constructs had a significantly smaller ROM in the quasi-static test (p = 0.028) and early in the cyclic test (p = 0.02); differences in the other parameters were not significant. There was a significant correlation between BMD and cycles to failure for the two-screw constructs (r = 0.94; p = 0.002) and for the screw-plus-spiral-blade constructs (r = 0.86; p = 0.014). In TTCA with a HAN Expert Nailing System, the use of a calcaneal spiral blade can further reduce motion within the construct. This may be especially useful in poor bone stock. Results obtained in this study could be used to guide the operating surgeon's TTCA strategy.

Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature.

PubMed

Bayoumi, Ahmed B; Efe, Ibrahim E; Berk, Selim; Kasper, Ekkehard M; Toktas, Zafer Orkun; Konya, Deniz

2018-03-01

The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. We reviewed PubMed/Medline by using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations. Copyright © 2017 Elsevier Inc. All rights reserved.

The use of intraoperative triggered electromyography to detect misplaced pedicle screws: a systematic review and meta-analysis.

PubMed

Mikula, Anthony L; Williams, Seth K; Anderson, Paul A

2016-04-01

Insertion of instruments or implants into the spine carries a risk for injury to neural tissue. Triggered electromyography (tEMG) is an intraoperative neuromonitoring technique that involves electrical stimulation of a tool or screw and subsequent measurement of muscle action potentials from myotomes innervated by nerve roots near the stimulated instrument. The authors of this study sought to determine the ability of tEMG to detect misplaced pedicle screws (PSs). The authors searched the U.S. National Library of Medicine, the Web of Science Core Collection database, and the Cochrane Central Register of Controlled Trials for PS studies. A meta-analysis of these studies was performed on a per-screw basis to determine the ability of tEMG to detect misplaced PSs. Sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) were calculated overall and in subgroups. Twenty-six studies were included in the systematic review. The authors analyzed 18 studies in which tEMG was used during PS placement in the meta-analysis, representing data from 2932 patients and 15,065 screws. The overall sensitivity of tEMG for detecting misplaced PSs was 0.78, and the specificity was 0.94. The overall ROC AUC was 0.96. A tEMG current threshold of 10-12 mA (ROC AUC 0.99) and a pulse duration of 300 µsec (ROC AUC 0.97) provided the most accurate testing parameters for detecting misplaced screws. Screws most accurately conducted EMG signals (ROC AUC 0.98). Triggered electromyography has very high specificity but only fair sensitivity for detecting malpositioned PSs.

Pull out strength calculator for pedicle screws using a surrogate ensemble approach.

PubMed

Varghese, Vicky; Ramu, Palaniappan; Krishnan, Venkatesh; Saravana Kumar, Gurunathan

2016-12-01

Pedicle screw instrumentation is widely used in the treatment of spinal disorders and deformities. Currently, the surgeon decides the holding power of instrumentation based on the perioperative feeling which is subjective in nature. The objective of the paper is to develop a surrogate model which will predict the pullout strength of pedicle screw based on density, insertion angle, insertion depth and reinsertion. A Taguchi's orthogonal array was used to design an experiment to find the factors effecting pullout strength of pedicle screw. The pullout studies were carried using polyaxial pedicle screw on rigid polyurethane foam block according to American society for testing of materials (ASTM F543). Analysis of variance (ANOVA) and Tukey's honestly significant difference multiple comparison tests were done to find factor effect. Based on the experimental results, surrogate models based on Krigging, polynomial response surface and radial basis function were developed for predicting the pullout strength for different combination of factors. An ensemble of these surrogates based on weighted average surrogate model was also evaluated for prediction. Density, insertion depth, insertion angle and reinsertion have a significant effect (p <0.05) on pullout strength of pedicle screw. Weighted average surrogate performed the best in predicting the pull out strength amongst the surrogate models considered in this study and acted as insurance against bad prediction. A predictive model for pullout strength of pedicle screw was developed using experimental values and surrogate models. This can be used in pre-surgical planning and decision support system for spine surgeon. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Reliability and Failure Modes of a Hybrid Ceramic Abutment Prototype.

PubMed

Silva, Nelson Rfa; Teixeira, Hellen S; Silveira, Lucas M; Bonfante, Estevam A; Coelho, Paulo G; Thompson, Van P

2018-01-01

A ceramic and metal abutment prototype was fatigue tested to determine the probability of survival at various loads. Lithium disilicate CAD-milled abutments (n = 24) were cemented to titanium sleeve inserts and then screw attached to titanium fixtures. The assembly was then embedded at a 30° angle in polymethylmethacrylate. Each (n = 24) was restored with a resin-cemented machined lithium disilicate all-ceramic central incisor crown. Single load (lingual-incisal contact) to failure was determined for three specimens. Fatigue testing (n = 21) was conducted employing the step-stress method with lingual mouth motion loading. Failures were recorded, and reliability calculations were performed using proprietary software. Probability Weibull curves were calculated with 90% confidence bounds. Fracture modes were classified with a stereomicroscope, and representative samples imaged with scanning electron microscopy. Fatigue results indicated that the limiting factor in the current design is the fatigue strength of the abutment screw, where screw fracture often leads to failure of the abutment metal sleeve and/or cracking in the implant fixture. Reliability for completion of a mission at 200 N load for 50K cycles was 0.38 (0.52% to 0.25 90% CI) and for 100K cycles was only 0.12 (0.26 to 0.05)-only 12% predicted to survive. These results are similar to those from previous studies on metal to metal abutment/fixture systems where screw failure is a limitation. No ceramic crown or ceramic abutment initiated fractures occurred, supporting the research hypothesis. The limiting factor in performance was the screw failure in the metal-to-metal connection between the prototyped abutment and the fixture, indicating that this configuration should function clinically with no abutment ceramic complications. The combined ceramic with titanium sleeve abutment prototype performance was limited by the fatigue degradation of the abutment screw. In fatigue, no ceramic crown or ceramic abutment components failed, supporting the research hypothesis with a reliability similar to that of all-metal abutment fixture systems. A lithium disilcate abutment with a Ti alloy sleeve in combination with an all-ceramic crown should be expected to function clinically in a satisfactory manner. © 2016 by the American College of Prosthodontists.

Effects on Subtalar Joint Stress Distribution After Cannulated Screw Insertion at Different Positions and Directions.

PubMed

Yuan, Cheng-song; Chen, Wan; Chen, Chen; Yang, Guang-hua; Hu, Chao; Tang, Kang-lai

2015-01-01

We investigated the effects on subtalar joint stress distribution after cannulated screw insertion at different positions and directions. After establishing a 3-dimensional geometric model of a normal subtalar joint, we analyzed the most ideal cannulated screw insertion position and approach for subtalar joint stress distribution and compared the differences in loading stress, antirotary strength, and anti-inversion/eversion strength among lateral-medial antiparallel screw insertion, traditional screw insertion, and ideal cannulated screw insertion. The screw insertion approach allowing the most uniform subtalar joint loading stress distribution was lateral screw insertion near the border of the talar neck plus medial screw insertion close to the ankle joint. For stress distribution uniformity, antirotary strength, and anti-inversion/eversion strength, lateral-medial antiparallel screw insertion was superior to traditional double-screw insertion. Compared with ideal cannulated screw insertion, slightly poorer stress distribution uniformity and better antirotary strength and anti-inversion/eversion strength were observed for lateral-medial antiparallel screw insertion. Traditional single-screw insertion was better than double-screw insertion for stress distribution uniformity but worse for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion was slightly worse for stress distribution uniformity than was ideal cannulated screw insertion but superior to traditional screw insertion. It was better than both ideal cannulated screw insertion and traditional screw insertion for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion is an approach with simple localization, convenient operation, and good safety. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Theoretical investigation of flash vaporisation in a screw expander

NASA Astrophysics Data System (ADS)

Vasuthevan, Hanushan; Brümmer, Andreas

2017-08-01

In the present study flash vaporisation of liquid injection in a twin screw expander for a Trilateral Flash Cycle (TFC) is examined theoretically. The TFC process comprises a pressure increase in the working fluid, followed by heating the liquid close to boiling point. The hot liquid is injected into the working chamber of a screw expander. During this process the pressure of the liquid drops below the saturation pressure, while the temperature of the liquid remains virtually constant. Hence the liquid is superheated and in a metastable state. The liquid jet seeks to achieve a stable state in thermodynamic equilibrium and is therefore partially vaporised. This effect is referred to as flash vaporisation. Accordingly, a two-phase mixture, consisting of vapour and liquid, exists in the working chamber. Thermodynamic simulations were carried out using water as the working fluid for representative screw expander geometry. The simulations presented are performed from two different aspects during the filling process of a screw expander. The first case is the vaporisation of the injected liquid in a state of thermodynamic equilibrium, whereby the two-phase mixture is treated entirely as a compressible and homogeneous gas. The second case considers flashing efficiency. It describes the quantity of flashed vapour and consists of a liquid and vapour domain. Both models are compared and analysed with respect to the operational behaviour of a screw expander.

Effect of the Coronal Wall Thickness of Dental Implants on the Screw Joint Stability in the Internal Implant-Abutment Connection.

PubMed

Lee, Ji-Hye; Huh, Yoon-Hyuk; Park, Chan-Jin; Cho, Lee-Ra

2016-01-01

To evaluate the effect of implant coronal wall thickness on load-bearing capacity and screw joint stability. Experimental implants were customized after investigation of the thinnest coronal wall thickness of commercially available implant systems with a regular platform diameter. Implants with four coronal wall thicknesses (0.2, 0.3, 0.4, and 0.5 mm) were fabricated. Three sets of tests were performed. The first set was a failure test to evaluate load-bearing capacity and elastic limit. The second and third sets were cyclic and static loading tests. After abutment screw tightening of each implant, vertical cyclic loading of 250 N or static loading from 250 to 800 N was applied. Coronal diameter expansion, axial displacement, and removal torque values of the implants were compared. Repeated measures analysis of variance (ANOVA) was used for statistical analysis (α = .05). Implants with 0.2-mm coronal wall thickness demonstrated significantly low load-bearing capacity and elastic limit (both P < .05). These implants also showed significantly large coronal diameter expansion and axial displacement after screw tightening (both P < .05). Greater vertical load and thinner coronal wall thickness significantly increased coronal diameter expansion of the implant, axial displacement of the abutment, and removal torque loss of the abutment screw (all P < .05). Implant coronal wall thickness of 0.2 mm produces significantly inferior load-bearing capacity and screw joint stability.

Effect of screw position on load transfer in lumbar pedicle screws: A non-idealized finite element analysis

PubMed Central

Newcomb, Anna G. U. S.; Baek, Seungwon; Kelly, Brian P.; Crawford, Neil R.

2016-01-01

Angled screw insertion has been advocated to enhance fixation strength during posterior spine fixation. Stresses on a pedicle screw and surrounding vertebral bone with different screw angles were studied by finite element analysis during simulated multidirectional loading. Correlations between screw-specific vertebral geometric parameters and stresses were studied. Angulations in both the sagittal and axial planes affected stresses on the cortical and cancellous bones and the screw. Pedicle screws pointing laterally (vs. straight or medially) in the axial plane during superior screw angulation may be advantageous in terms of reducing the risk of both screw loosening and screw breakage. PMID:27454197

A comparison of parallel and diverging screw angles in the stability of locked plate constructs.

PubMed

Wähnert, D; Windolf, M; Brianza, S; Rothstock, S; Radtke, R; Brighenti, V; Schwieger, K

2011-09-01

We investigated the static and cyclical strength of parallel and angulated locking plate screws using rigid polyurethane foam (0.32 g/cm(3)) and bovine cancellous bone blocks. Custom-made stainless steel plates with two conically threaded screw holes with different angulations (parallel, 10° and 20° divergent) and 5 mm self-tapping locking screws underwent pull-out and cyclical pull and bending tests. The bovine cancellous blocks were only subjected to static pull-out testing. We also performed finite element analysis for the static pull-out test of the parallel and 20° configurations. In both the foam model and the bovine cancellous bone we found the significantly highest pull-out force for the parallel constructs. In the finite element analysis there was a 47% more damage in the 20° divergent constructs than in the parallel configuration. Under cyclical loading, the mean number of cycles to failure was significantly higher for the parallel group, followed by the 10° and 20° divergent configurations. In our laboratory setting we clearly showed the biomechanical disadvantage of a diverging locking screw angle under static and cyclical loading.

In vivo surface analysis of titanium and stainless steel miniplates and screws.

PubMed

Matthew, I R; Frame, J W; Browne, R M; Millar, B G

1996-12-01

This study was undertaken to characterize the surfaces of Champy titanium and stainless steel miniplates and screws that had been used to stabilize fractures of the mandible in an animal model. Miniplates and screws were retrieved at 4, 12, and 24 weeks after surgery. Low-vacuum scanning electron microscopy (SEM) of autoclaved unused (control) and test miniplates from the same production batches was undertaken. Energy-dispersive X-ray (EDX) analysis was used to identify compositional variations of the miniplate surface, and Vickers hardness testing was performed. At autopsy, clinical healing of all fractures was noted. SEM analysis indicated no perceptible difference in the surface characteristics of the miniplates at all time intervals. Aluminium and silicon deposits were identified by EDX analysis over the flat surfaces. There was extensive damage to some screw heads. It is concluded that there were no significant changes in the surface characteristics of miniplates retrieved up to 24 weeks after implantation in comparison with controls. Damage to the screws during insertion due to softness of the materials may render their removal difficult. There was no evidence to support the routine removal of titanium or stainless steel miniplates because of surface corrosion up to 6 months after implantation.

Biomechanical evaluation of a new composite bioresorbable screw.

PubMed

Bailey, C A; Kuiper, J H; Kelly, C P

2006-04-01

A new bioresorbable composite cannulated screw has been developed for small bone fracture fixation. The LG ("Little Grafter") screw is manufactured from Biosteon, which is a composite of poly L-lactic acid and hydroxyapatite. This study aimed to compare interfragmentary compression generated by this new screw with conventional metal screws commonly used in scaphoid fracture fixation. Four small metallic screws were compared with the LG screw, using a bone model produced from rigid polyurethane foam. The screws included the Acutrak, Asnis III, Herbert and Herbert-Whipple screws. The mean maximum compression forces for the LG screw, the Asnis and the Acutrak were comparable (LG 32.3 N, Asnis 32.8 N, Acutrak 38.3 N), whereas those using the Herbert and the Herbert-Whipple screw were significantly lower (Herbert 21.8 N, Herbert-Whipple 19.9 N). The bioresorbable LG screw has been shown to have good compressive properties compared to commonly used small bone fragment compression screws.

Which is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell.

PubMed

Yu, Bin-Sheng; Yang, Zhan-Kun; Li, Ze-Min; Zeng, Li-Wen; Wang, Li-Bing; Lu, William Weijia

2011-08-01

An in vitro biomechanical cadaver study. To evaluate the pull-out strength after 5000 cyclic loading among 4 revision techniques for the loosened iliac screw using corticocancellous bone, longer screw, traditional cement augmentation, and boring cement augmentation. Iliac screw loosening is still a clinical problem for lumbo-iliac fusion. Although many revision techniques using corticocancellous bone, larger screw, and polymethylmethacrylate (PMMA) augmentation were applied in repairing pedicle screw loosening, their biomechanical effects on the loosened iliac screw remain undetermined. Eight fresh human cadaver pelvises with the bone mineral density values ranging from 0.83 to 0.97 g/cm were adopted in this study. After testing the primary screw of 7.5 mm diameter and 70 mm length, 4 revision techniques were sequentially established and tested on the same pelvis as follows: corticocancellous bone, longer screw with 100 mm length, traditional PMMA augmentation, and boring PMMA augmentation. The difference of the boring technique from traditional PMMA augmentation is that PMMA was injected into the screw tract through 3 boring holes of outer cortical shell without removing the screw. On an MTS machine, after 5000 cyclic compressive loading of -200∼-500 N to the screw head, axial maximum pull-out strengths of the 5 screws were measured and analyzed. The pull-out strengths of the primary screw and 4 revised screws with corticocancellous bone, longer screw and traditional and boring PMMA augmentation were 1167 N, 361 N, 854 N, 1954 N, and 1820 N, respectively. Although longer screw method obtained significantly higher pull-out strength than corticocancellous bone (P<0.05), the revised screws using these 2 techniques exhibited notably lower pull-out strength than the primary screw and 2 PMMA-augmented screws (P<0.05). Either traditional or boring PMMA screw showed obviously higher pull-out strength than the primary screw (P<0.05); however, no significant difference of pull-out strength was detected between the 2 PMMA screws (P>0.05). Wadding corticocancellous bone and increasing screw length failed to provide sufficient anchoring strength for a loosened iliac screw; however, both traditional and boring PMMA-augmented techniques could effectively increase the fixation strength. On the basis of the viewpoint of minimal invasion, the boring PMMA augmentation may serve as a suitable salvage technique for iliac screw loosening.

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

PubMed

White, Alexander A; Kubacki, Meghan R; Samona, Jason; Telehowski, Paul; Atkinson, Patrick J

2016-06-01

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. © IMechE 2016.

Influence of the implant abutment types and the dynamic loading on initial screw loosening

PubMed Central

Kim, Eun-Sook

2013-01-01

PURPOSE This study examined the effects of the abutment types and dynamic loading on the stability of implant prostheses with three types of implant abutments prepared using different fabrication methods by measuring removal torque both before and after dynamic loading. MATERIALS AND METHODS Three groups of abutments were produced using different types of fabrication methods; stock abutment, gold cast abutment, and CAD/CAM custom abutment. A customized jig was fabricated to apply the load at 30° to the long axis. The implant fixtures were fixed to the jig, and connected to the abutments with a 30 Ncm tightening torque. A sine curved dynamic load was applied for 105 cycles between 25 and 250 N at 14 Hz. Removal torque before loading and after loading were evaluated. The SPSS was used for statistical analysis of the results. A Kruskal-Wallis test was performed to compare screw loosening between the abutment systems. A Wilcoxon signed-rank test was performed to compare screw loosening between before and after loading in each group (α=0.05). RESULTS Removal torque value before loading and after loading was the highest in stock abutment, which was then followed by gold cast abutment and CAD/CAM custom abutment, but there were no significant differences. CONCLUSION The abutment types did not have a significant influence on short term screw loosening. On the other hand, after 105 cycles dynamic loading, CAD/CAM custom abutment affected the initial screw loosening, but stock abutment and gold cast abutment did not. PMID:23509006

Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading.

PubMed

Lindtner, Richard A; Schmid, Rene; Nydegger, Thomas; Konschake, Marko; Schmoelz, Werner

2018-03-01

Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws. In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm 3  ± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm 3  ± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from - 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion ("screw toggling") within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles. The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles, p = 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws, p = 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure. Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy. These slides can be retrieved under Electronic Supplementary Material.

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study.

PubMed

Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-11

Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p < 0.05). The mean score for the level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.

A new palatal distractor device for bodily movement of maxillary bones by rigid self-locking miniplates and screws system.

PubMed

Cortese, Antonio; Savastano, Mauro; Cantone, Antonio; Claudio, Pier Paolo

2013-07-01

A new palatal distractor device for bodily movement of the maxillary bones after complete segmented Le Fort I osteotomy for 1-stage transversal distraction and tridimensional repositioning on 1 patient is presented. The new distractor has an intrinsic tridimensional rigidity also in the fixation system by self-locking miniplates and screws for better control of the 2 maxillary fragments during distraction. Le Fort I distraction and repositioning procedure in association with a bilateral sagittal split osteotomy were performed on 1 patient with complete solution of the cross-bite and class III malocclusion. Results of dental and cephalometric analysis performed before surgery (T1), after surgery and distraction time (T2), and 18 months after surgery and orthodontic appliance removal (T3) are reported. No complications were encountered using the new distractor device. Advantages of this device and technique are presented including improved rigidity of both distraction (jackscrew) and fixation (4 self-locking miniplates and screws) systems resulting in complete control of the position of the 2 maxillary fragments during distraction and surgery. In addition, this new device allows resuming palatal distraction in the event of cross-bite relapse without causing dental-related problems or the risks of screw slackening.

Characteristics of pedicle screw loading. Effect of sagittal insertion angle on intrapedicular bending moments.

PubMed

Youssef, J A; McKinley, T O; Yerby, S A; McLain, R F

1999-06-01

A bending analysis of pedicle screws inserted into vertebral body analogues. Intravertebral and intrapedicular pedicle screw bending moments were studied as a function of sagittal insertion angle. To determine how the pedicle screw bending moment is affected by changes in the insertion angle. There is a significant incidence of failure when pedicle screws are used to instrument unstable spinal segments. Extrinsic factors that affect screw bending failure have been poorly characterized. Previous work has demonstrated that intrapedicular pedicle screw bending moments are significantly affected by the sagittal location and depth of pedicle screw placement. Pedicle screw transducers were inserted in analogue vertebrae at one of three orientations: 7 degrees cephalad (toward the superior endplate), 7 degrees caudal (toward the inferior endplate), or parallel to the superior endplate (control). An axial load was applied to the superior endplate of the vertebra, and screw bending moments were recorded directly from the transducers. Screws angled 7 degrees cephalad developed significantly greater mean intrapedicular bending moments compared with screws inserted caudal or control screws. There was no significant difference in bending moments realized within the vertebral body for the three screw positions. Angulating pedicle screws toward the superior endplate increased bending moments within the pedicle. If attention to optimal screw insertion technique can reduce bending moments and potential for screw failure without increasing morbidity, surgical risk, or operative time, then proper insertion technique takes on new importance.

A Comparison of Removal Rates of Headless Screws Versus Headed Screws in Calcaneal Osteotomy.

PubMed

Kunzler, Daniel; Shazadeh Safavi, Pejma; Jupiter, Daniel; Panchbhavi, Vinod K

2017-11-01

Calcaneal osteotomy has been used to successfully treat both valgus and varus hindfoot deformities. Pain associated with implanted hardware may lead to further surgical intervention for hardware removal. Headless screws have been used to reduce postoperative hardware-associated pain and accompanying hardware removal, but data proving their effectiveness in this regard is lacking. The purpose of this study is to compare the rates of removal of headed and headless screws utilized in calcaneal osteotomy. We conducted a retrospective chart review of 74 patients who underwent calcaneal osteotomy between January 2010 and December 2014. The cohort was divided into 2 groups by fixation method: a headed screw and a headless screw group. Bivariate associations between infection or hardware removal, and screw type, screw head width, gender, smoking status, alcohol, hypertension, diabetes, hyperlipidemia, age, and body mass index were assessed using t-tests and Fisher's exact/χ 2 tests for continuous and discrete variables, respectively. Headed screws were removed more frequently than headless screws (P < .0001): 15 of 30 (50%) feet that received headed screws and 4 of 44 (9%) of feet that received headless screws underwent subsequent revision for screw removal. In all cases, screws were removed because of pain. The calcaneal union rate was 100% in both cohorts. The rate of screw removal in calcaneal osteotomies is significantly lower in patients who receive headless screws than in those receiving headed screws. Level IV.

Metallic artifacts from internal scaphoid fracture fixation screws: comparison between C-arm flat-panel, cone-beam, and multidetector computed tomography.

PubMed

Finkenstaedt, Tim; Morsbach, Fabian; Calcagni, Maurizio; Vich, Magdalena; Pfirrmann, Christian W A; Alkadhi, Hatem; Runge, Val M; Andreisek, Gustav; Guggenberger, Roman

2014-08-01

The aim of this study was to compare image quality and extent of artifacts from scaphoid fracture fixation screws using different computed tomography (CT) modalities and radiation dose protocols. Imaging of 6 cadaveric wrists with artificial scaphoid fractures and different fixation screws was performed in 2 screw positions (45° and 90° orientation in relation to the x/y-axis) using multidetector CT (MDCT) and 2 flat-panel CT modalities, C-arm flat-panel CT (FPCT) and cone-beam CT (CBCT), the latter 2 with low and standard radiation dose protocols. Mean cartilage attenuation and metal artifact-induced absolute Hounsfield unit changes (= artifact extent) were measured. Two independent radiologists evaluated different image quality criteria using a 5-point Likert-scale. Interreader agreements (Cohen κ) were calculated. Mean absolute Hounsfield unit changes and quality ratings were compared using Friedman and Wilcoxon signed-rank tests. Artifact extent was significantly smaller for MDCT and standard-dose FPCT compared with CBCT low- and standard-dose acquisitions (all P < 0.05). No significant differences in artifact extent among different screw types and scanning positions were noted (P > 0.05). Both MDCT and FPCT standard-dose protocols showed equal ratings for screw bone interface, fracture line, and trabecular bone evaluation (P = 0.06, 0.2, and 0.2, respectively) and performed significantly better than FPCT low- and CBCT low- and standard-dose acquisitions (all P < 0.05). Good interreader agreement was found for image quality comparisons (Cohen κ = 0.76-0.78). Both MDCT and FPCT standard-dose acquisition showed comparatively less metal-induced artifacts and better overall image quality compared with FPCT low-dose and both CBCT acquisitions. Flat-panel CT may provide sufficient image quality to serve as a versatile CT alternative for postoperative imaging of internally fixated wrist fractures.

Performance of an adjustable, threaded inertance tube

NASA Astrophysics Data System (ADS)

Zhou, W. J.; Pfotenhauer, J. M.; Nellis, G. F.; Liu, S. Y.

2015-12-01

The performance of the Stirling type pulse tube cryocooler depends strongly on the design of the inertance tube. The phase angle produced by the inertance tube is very sensitive to its diameter and length. Recent developments are reported here regarding an adjustable inertance device that can be adjusted in real time. The inertance passage is formed by the root of a concentric cylindrical threaded device. The depth of the threads installed on the outer screw varies. In this device, the outer screw can be rotated four and half turns. At the zero turn position the length of the passage is 1.74 m and the hydraulic diameter is 7 mm. By rotating the outer screw, the inner threaded rod engages with additional, larger depth threads. Therefore, at its upper limit of rotation, the inertance passage includes both the original 1.74 m length with 7mm hydraulic diameter plus an additional 1.86 m length with a 10 mm hydraulic diameter. A phase shift change of 24° has been experimentally measured by changing the position of outer screw while operating the device at a frequency of 60 Hz. This phase angle shift is less than the theoretically predicted value due to the presence of a relatively large leak through the thread clearance. Therefore, the distributed component model of the inertance tube was modified to account for the leak path causing the data to agree with the model. Further, the application of vacuum grease to the threads causes the performance of the device to improve substantially.

Biomechanical in vitro - stability testing on human specimens of a locking plate system against conventional screw fixation of a proximal first metatarsal lateral displacement osteotomy.

PubMed

Arnold, Heino; Stukenborg-Colsman, Christina; Hurschler, Christof; Seehaus, Frank; Bobrowitsch, Evgenij; Waizy, Hazibullah

2012-01-01

The aim of this study was to examine resistance to angulation and displacement of the internal fixation of a proximal first metatarsal lateral displacement osteotomy, using a locking plate system compared with a conventional crossed screw fixation. Seven anatomical human specimens were tested. Each specimen was tested with a locking screw plate as well as a crossed cancellous srew fixation. The statistical analysis was performed by the Friedman test. The level of significance was p = 0.05. We found larger stability about all three axes of movement analyzed for the PLATE than the crossed screws osteosynthesis (CSO). The Friedman test showed statistical significance at a level of p = 0.05 for all groups and both translational and rotational movements. The results of our study confirm that the fixation of the lateral proximal first metatarsal displacement osteotomy with a locking plate fixation is a technically simple procedure of superior stability.

Biomechanical In Vitro - Stability Testing on Human Specimens of a Locking Plate System Against Conventional Screw Fixation of a Proximal First Metatarsal Lateral Displacement Osteotomy

PubMed Central

Arnold, Heino; Stukenborg-Colsman, Christina; Hurschler, Christof; Seehaus, Frank; Bobrowitsch, Evgenij; Waizy, Hazibullah

2012-01-01

Introduction: The aim of this study was to examine resistance to angulation and displacement of the internal fixation of a proximal first metatarsal lateral displacement osteotomy, using a locking plate system compared with a conventional crossed screw fixation. Materials and Methodology: Seven anatomical human specimens were tested. Each specimen was tested with a locking screw plate as well as a crossed cancellous srew fixation. The statistical analysis was performed by the Friedman test. The level of significance was p = 0.05. Results: We found larger stability about all three axes of movement analyzed for the PLATE than the crossed screws osteosynthesis (CSO). The Friedman test showed statistical significance at a level of p = 0.05 for all groups and both translational and rotational movements. Conclusion: The results of our study confirm that the fixation of the lateral proximal first metatarsal displacement osteotomy with a locking plate fixation is a technically simple procedure of superior stability. PMID:22675409

Joint kinematics of surgeons during lumbar pedicle screw placement.

PubMed

Park, Jeong-Yoon; Kim, Kyung-Hyun; Kuh, Sung-Uk; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun

2016-12-01

A surgical robot for spine surgery has recently been developed. The objective is to assess the joint kinematics of the surgeon during spine surgery. We enrolled 18 spine surgeons, who each performed pedicle screw placement, and used an optoelectronic motion analysis system. Using three-dimensional (3D) motion images, distance changes in five joints and angle changes in six joints were calculated during surgery. Distance fluctuations increased gradually from the proximal to the distal joint. Angle fluctuations were largest at the distal point but did not gradually increase, and the elbow showed the second largest fluctuation. Changes along the X axis were larger than those of the Y and Z axes. The distances gradually increased from proximal portions of the body to the hand. In angle changes, the elbow was most dynamic during pedicle screw placement. The surgeons' whole joints carry out a harmonic role during lumbar pedicle screw placement. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation

PubMed Central

Nunez, Fiesky A.; Luo, T. David; Jupiter, Jesse B.; Nunez, Fiesky A.

2016-01-01

Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity. PMID:28344539

[Evaluation of the risk of mediastinal or retroperitoneal injuries caused by dorso-lumbar pedicle screws].

PubMed

Hernigou, P; Germany, W

1998-09-01

Within an anatomical and a clinical study, the authors employed computerized tomographic scans to evaluate the risks of anterior surrounding tissues injuries during screw insertion. CT scans of 20 patients suffering from cardiac disease were reviewed retrospectively. Scans through the thoracic and lumbar spine were obtained using 6 mm slice thickness. These examinations were performed with intravenous contrast medium. Measurements of vessel diameters and distance of the soft tissues situated directly anterior to the spine were done. A retrospective study of 61 pedicle screws implanted for spine fractures evaluated the penetration of the anterior vertebral cordex with X rays and CT scans. Computerized tomographic scans of the thoracic and lumbar spine of the 20 patients in the control group confirmed proximity of the posterior mediastinal structures to the anterior vertebral cortex. Many structures of the posterior mediastinum were within five millimeters of the anterior vertebral cortex and thus were at risk: aorta, azygos vein, vena cava, parietal pleura and lungs. The theoretical risk of unrecognized screw penetrations evaluated on geometric shape of the anterior vertebral body is as high as 21 per cent when screw position is only seen with an antero posterior and a lateral X Ray. In the other group, computerized tomographic scans showed that 30 per cent of the implanted screws were outside the boundaries of the anterior thoracic spine. Two orthogonal incidences do not enable determination of whether the extremity of the screw is slightly outside the anterior cortex of the vertebral body. However the geometric shape of the anterior vertebral body enables peroperative definition of a safety zone on two orthogonal incidences. Even if a breach of a few millimeters of the anterior cortical boundaries of the vertebral body may not initially damage the adjacent soft-tissue structures, chronic irritation may result in late damages of these structures. The use of metallic markers and the respect of a safe vertebral zone on X Rays could guide the choice of the appropriate screw length.

Biomechanical study of anterior spinal instrumentation configurations

PubMed Central

Cloutier, Luc P.; Grimard, Guy

2007-01-01

The biomechanical impact of the surgical instrumentation configuration for spine surgery is hard to evaluate by the surgeons in pre-operative situation. This study was performed to evaluate different configurations of the anterior instrumentation of the spine, with simulated post-operative conditions, to recommend configurations to the surgeons. Four biomechanical parameters of the anterior instrumentation with simulated post-operative conditions have been studied. They were the screw diameter (5.5–7.5 mm) and its angle (0°–22.5°), the bone grip of the screw (mono–bi cortical) and the amount of instrumented levels (5–8). Eight configurations were tested using an experimental plan with instrumented synthetic spinal models. A follower load was applied and the models were loaded in flexion, torsion and lateral bending. At 5 Nm, average final stiffness was greater in flexion (0.92 Nm/°) than in lateral bending (0.56 Nm/°) and than in torsion (0.26 Nm/°). The screw angle was the parameter influencing the most the final stiffness and the coupling behaviors. It has a significant effect (p ≤ 0.05) on increasing the final stiffness for a 22.5° screw angle in flexion and for a coronal screw angle (0°) in lateral bending. The bi-cortical bone grip of the screw significantly increased the initial stiffness in flexion and lateral bending. Mathematical models representing the behavior of an instrumented spinal model have been used to identify optimal instrumentation configurations. A variation of the angle of the screw from 22.5° to 0° gave a global final stiffness diminution of 13% and a global coupling diminution of 40%. The screw angle was the most important parameter affecting the stiffness and the coupling of the instrumented spine with simulated post-operative conditions. Information about the effect of four different biomechanical parameters will be helpful in preoperative situations to guide surgeons in their clinical choices. PMID:17205240

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation.

PubMed

Chan, Chris Yin Wei; Kwan, Mun Keong; Saw, Lim Beng

2010-01-01

The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

Grading apical vertebral rotation without a computed tomography scan: a clinically relevant system based on the radiographic appearance of bilateral pedicle screws.

PubMed

Upasani, Vidyadhar V; Chambers, Reid C; Dalal, Ali H; Shah, Suken A; Lehman, Ronald A; Newton, Peter O

2009-08-01

Bench-top and retrospective analysis to assess vertebral rotation based on the appearance of bilateral pedicle screws in patients with adolescent idiopathic scoliosis (AIS). To develop a clinically relevant radiographic grading system for evaluating postoperative thoracic apical vertebral rotation that would correlate with computed tomography (CT) measures of rotation. The 3-column vertebral body control provided by bilateral pedicle screws has enabled scoliosis surgeons to develop advanced techniques of direct vertebral derotation. Our ability to accurately quantify spinal deformity in the axial plane, however, continues to be limited. Trigonometry was used to define the relationship between the position of bilateral pedicle screws and vertebral rotation. This relationship was validated using digital photographs of a bench-top model. The mathematical relationships were then used to calculate vertebral rotation from standing postoperative, posteroanterior radiographs in AIS patients and correlated with postoperative CT measures of rotation. Fourteen digital photographs of the bench-top model were independently analyzed twice by 3 coauthors. The mathematically calculated degree of rotation was found to correlate significantly with the actual degree of rotation (r = 0.99; P < 0.001) and the intra- and interobserver reliability for these measurements were both excellent (kappa = 0.98 and kappa = 0.97, respectively). In the retrospective analysis of 17 AIS patients, the average absolute difference between the radiographic measurement of rotation and the CT measure was only 1.9 degrees +/- 2.0 degrees (r = 0.92; P < 0.001). Based on these correlations a simple radiographic grading system for postoperative apical vertebral rotation was developed. An accurate assessment of vertebral rotation can be performed radiographically, using screw lengths and screw tip-to-rod distances of bilateral segmental pedicle screws and a trigonometric calculation. These data support the use of a simple radiographic grading system to approximate apical vertebral rotation in AIS patients treated with bilateral apical pedicle screws.

The Biomechanical Properties of Pedicle Screw Fixation Combined With Trajectory Bone Cement Augmentation in Osteoporotic Vertebrae.

PubMed

Fan, Haitao T; Zhang, Renjie J; Shen, Cailiang L; Dong, Fulong L; Li, Yong; Song, Peiwen W; Gong, Chen; Wang, Yijin J

2016-03-01

The biomechanics of pedicle screw fixation combined with trajectory cement augmentation with various filling volumes were measured by pull-out, periodic antibending, and compression fatigue tests. To investigate the biomechanical properties of the pedicle screw fixation combined with trajectory bone cement (polymethylmethacrylate) augmentation in osteoporotic vertebrae and to explore the optimum filling volume of the bone cement. Pedicle screw fixation is considered to be the most effective posterior fixation method. The decrease of the bone mineral density apparently increases the fixation failure risk caused by screw loosening and displacement. Trajectory bone cement augmentation has been confirmed to be an effective method to increase the bone intensity and could markedly increase the stability of the fixation interface. Sixteen elderly cadaveric 1-5 lumbar vertebral specimens were diagnosed with osteoporosis. The left and right vertebral pedicles were alternatively randomized for treatment in all groups, with the contralateral pedicles as control. The study groups included: group A (pedicle screw fixation with full trajectory bone cement augmentation), group B (75% filling), group C (50% filling), and group D (25% filling). Finally, the bone cement leakage and dispersion were assessed and the mechanical testing was conducted. The bone cement was well dispersed around the pedicle screw. The augmented bone intensity, pull-out strength, periodic loading times, and compression fatigue performance were markedly higher than those of the control groups. With the increase in trajectory bone cement, the leakage was also increased (P<0.05). The pull-out strength of the pedicle screw was increased with an increase in bone mineral density and trajectory bone cement. It peaked at 75% filling, with the largest power consumption. The optimal filling volume of the bone cement was 75% of the trajectory volume (about 1.03 mL). The use of excessive bone cement did not increase the fixation intensity but increased the risk of leakage.

Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

PubMed

Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

2016-02-01

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Reconstruction of the lateral tibia plateau fracture with a third triangular support screw: A biomechanical study.

PubMed

Moran, Eduardo; Zderic, Ivan; Klos, Kajetan; Simons, Paul; Triana, Miguel; Richards, R Geoff; Gueorguiev, Boyko; Lenz, Mark

2017-10-01

Split fractures of the lateral tibia plateau in young patients with good bone quality are commonly treated using two minimally invasive percutaneous lag screws, followed by unloading of the knee joint. Improved stability could be achieved with the use of a third screw inserted either in the jail-technique fashion or with a triangular support screw configuration. The aim of this study was to investigate under cyclic loading the compliance and endurance of the triangular support fixation in comparison with the standard two lag-screw fixation and the jail technique. Lateral split fractures of type AO/OTA 41-B1 were created on 21 synthetic tibiae and subsequently fixed with one of the following three techniques for seven specimens: standard fixation by inserting two partially threaded 6.5 mm cannulated lag screws parallel to each other and orthogonal to the fracture plane; triangular support fixation-standard fixation with one additional support screw at the distal end of the fracture at 30° proximal inclination; and jail fixation-standard fixation with one additional orthogonal support screw inserted in the medial nonfractured part of the bone. Mechanical testing was performed under progressively increasing cyclic compression loading. Fragment displacement was registered via triggered radiographic imaging. Mean construct compliance was 3.847 × 10 -3  mm/N [standard deviation (SD) 0.784] for standard fixation, 3.838 × 10 -3  mm/N (SD 0.242) for triangular fixation, and 3.563 × 10 -3  mm/N (SD 0.383) for jail fixation, with no significant differences between the groups ( p  = 0.525). The mean numbers of cycles to 2 mm fragment dislocation, defined as a failure criterion, were 12,384 (SD 2267) for standard fixation, 17,708 (SD 2193) for triangular fixation, and 14,629 (SD 5194) for jail fixation. Triangular fixation revealed significantly longer endurance than the standard one ( p  = 0.047). Triangular support fixation enhanced interfragmentary stability at the ultimate stage of dynamic loading. However, the level of improvement seems to be limited and may not legitimate the intervention with an additional third screw.

Sagittal plane analysis of selective posterior thoracic spinal fusion in adolescent idiopathic scoliosis: a comparison study of all pedicle screw and hybrid instrumentation.

PubMed

Liu, Tie; Hai, Yong

2014-07-01

To compare sagittal profiles of selective posterior thoracic instrumentation with segmental pedicle screws instrumentation and hybrid (hook and pedicle screw). Nowadays, thoracic screws are considered more effective than other constructs in spinal deformity correction and have become the treatment in adolescent idiopathic scoliosis surgery. However, recent research found that this enhanced correction ability may sacrifice sagittal balance. As lumbar lordosis is dependent upon thoracic kyphosis (TK), it has been important to maintain TK magnitude in selective thoracic fusions to keep balance. There is no sagittal measurement analysis between the hybrid and all-screw constructs type in cases of selective thoracic fusion. All adolescent idiopathic scoliosis (Lenke1) patients surgically treated in our department between 2003 and 2008 were reviewed. Radiographs of these patients, whose preoperative, immediately postoperative, and minimum 2-year follow-up after selective thoracic fusion (lower instrumented vertebrae not lower than L1, hybrid group the pedicle screw instrumentation not higher than T10) were evaluated, 21 patients underwent posterior hybrid instrumentation and 21 underwent pedicle screw instrumentation. No significant difference in sagittal profiles was observed between the 2 groups. At final follow-up, the proximal junctional measurement has a minor increase in both the groups. TK (T5-T12) also increased (+2.0 degrees of increase in hybrid group vs. +3.9 degrees of increase in the pedicle screw group). The effect of different instrumentation in changing TK at various time points between 2 groups was statistic different (P=0.004). Lumbar lordosis (L1-L5) was increased in both the groups. No significant changes in distal junctional measurement and thoracolumbar junction were noted. The C7 sagittal plumbline remained negative in both the groups at the final follow-up. There was no statistically significant difference comparing the sagittal alignment parameter of pedicle screw and hybrid constructs except for selective TK correction have differences. If used properly, both kinds of instrumentation could result in acceptable sagittal profiles when selective thoracic fusions were performed.

The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion.

PubMed

Deng, Ting; Jiang, Minghui; Lei, Qing; Cai, Lihong; Chen, Li

2016-12-01

Clinical trial for cervical screw insertion by using individualized 3-dimensional (3D) printing screw insertion templates device. The objective of this study is to evaluate the safety and accuracy of the individualized 3D printing screw insertion template in the cervical spine. Ten patients who underwent posterior cervical fusion surgery with cervical pedicle screws, laminar screws or lateral mass screws between December 2014 and December 2015 were involved in this study. The patients were examined by CT scan before operation. The individualized 3D printing templates were made with photosensitive resin by a 3D printing system to ensure the screw shafts entered the vertebral body without breaking the pedicle or lamina cortex. The templates were sterilized by a plasma sterilizer and used during the operation. The accuracy and the safety of the templates were evaluated by CT scans at the screw insertion levels after operation. The accuracy of this patient-specific template technique was demonstrated. Only one screw axis greatly deviated from the planned track and breached the cortex of the pedicle because the template was split by rough handling and then we inserted the screws under the fluoroscopy. The remaining screws were inserted in the track as preoperative design and the screw axis deviated by less than 2 mm. Vascular or neurologic complications or injuries did not happen. And no infection, broken nails, fracture of bone structure, or screw pullout occurred. This study verified the safety and the accuracy of the individualized 3D printing screw insertion templates in the cervical spine as a kind of intraoperative screw navigation. This individualized 3D printing screw insertion template was user-friendly, moderate cost, and enabled a radiation-free cervical screw insertion.

Evaluation of the success and complication rates of self-drilling orthodontic mini-implants.

PubMed

Gurdan, Z; Szalma, J

2018-05-01

Orthodontic mini-implants are important devices for successful anchorage management in orthodontics; however, the survival of these devices depends on several clinical factors. The aim of our study was to calculate the success and complication rates of orthodontic mini-implants. In this retrospective study, patients of our orthodontic department were enrolled, getting overall 59 orthodontic mini-implants during their orthodontic treatment in a 2-year period. Every patient had one or more of the 1.6 mm × 8 mm in size self-drilling mini-implants (Jeil Dual Top Anchor System, Jeil Medical Corp., Seoul, Korea). Screw loading was performed immediately after insertions, keeping tension forces under 150 g. Soft tissue and bone infections, implant mobility and screw loss, implant fracture, and neighboring tooth injury were registered. Relationships between variables were tested using the Chi-square test for statistical significance. The success rate of the orthodontic mini-implants was 89.8% in this study while the average loading period was 8.1 months. Soft-tissue infections varied between 6.3% and 33.3% of the cases while screw mobility varied between 3.1% and 20.8% of the cases regarding the anatomic localization. Screw mobility was significantly more frequent in the buccal fold than in the palate (P = 0.034). Screw mobility was significantly more frequent in the buccal fold than in the palate (P = 0.034) and screw mobility was found more frequently in case of intrusions than by extrusions (P = 0.036). The overall success rate of mini-implants was found acceptable in this study, however, screw mobility in the buccal fold showed a high incidence, suggesting the thorough consideration of the immediate loading by buccal mini-implants.

Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures.

PubMed

Beltran, Michael J; Mitchell, Phillip M; Collinge, Cory A

2016-10-01

Screws placed from posterior to anterior have been shown to be biomechanically and anatomically superior in the fixation of talar neck and neck-body fractures, yet most surgeons continue to place screws from an anterior start point. The safety and efficacy of percutaneously applied posterior screws has not been clinically defined, and functional outcomes after their use is lacking. After institutional review board approval, we performed a retrospective review of 24 consecutive talar neck fractures treated by a single surgeon that utilized posterior-to-anterior screw fixation. Clinical, radiographic, and functional outcomes were assessed at a minimum follow-up of 12 months. Functional outcomes including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud-Molander Scores, and the Short Form 36 (SF-36) measurement were collected and reviewed. Average patient follow-up was 44 months. According to the classification system of Canale and Kelly, there were 4 type I fractures, 15 type II fractures, 4 type III fractures, and 1 type IV fracture. Four patients had open fractures. One superficial wound infection occurred, 1 patient reported FHL stiffness, and 6 complained of numbness or paresthesias in the distribution of the sural nerve (5 transient, 1 permanent). One reoperation was required to exchange a screw impinging on the talonavicular joint. Radiographically, 44% developed a positive Hawkins sign, and the specificity of this finding was 100% for talar dome viability. Avascular necrosis developed in 43% of patients, with 33% revascularizing and none going on to collapse. Subtalar arthrosis developed in 62% of patients. Screws placed from posterior to anterior are a useful technique in the treatment of talar neck fractures. Functional outcomes following their use appear favorable compared with recent reports with minimal risk to local structures. Level IV, retrospective case series. © The Author(s) 2016.

Biomechanical comparison of cemented versus non-cemented anterior screw fixation in type II odontoid fractures in the elderly: a cadaveric study.

PubMed

Rehousek, Petr; Jenner, Edward; Holton, James; Czyz, Marcin; Capek, Lukas; Henys, Petr; Kulvajtova, Marketa; Krbec, Martin; Skala-Rosenbaum, Jiri

2018-05-18

Odontoid process fractures are the most common injuries of the cervical spine in the elderly. Anterior screw stabilization of type II odontoid process fractures improves survival and function in these patients but may be complicated by failure of fixation. The present study aimed to determine whether cement augmentation of a standard anterior screw provides biomechanically superior fixation of type II odontoid fractures in comparison with a non-cemented standard screw. Twenty human cadaveric C2 vertebrae from elderly donors (mean age 83 years) were obtained. Anderson and D'Alonzo type IIa odontoid fracture was created by transverse osteotomy, and fluoroscopy-guided anterior screw fixation was performed. The specimens were divided into two matched groups. The cemented group (n=10) had radiopaque high viscosity polymethylmethacrylate cement injected via Jamshidi needle into the base of the odontoid process. The other group was not augmented. A V-shaped punch was used for loading the odontoid in an anteroposterior direction until failure. The failure state was defined as screw cutout or 5% force decrease. Mean failure load and bending stiffness were calculated. The mean failure load for the cemented group was 352±12 N compared with 168±23 N for the non-cemented group (p<.001). The mean initial stiffness of the non-cemented group was 153±19 N/mm compared with 195±29 N/mm for the cemented group (p<.001) CONCLUSIONS: Cement augmentation of an anterior standard screw fixation of type II odontoid process fractures in elderly patients significantly increased load to failure under anteroposterior load in comparison with non-augmented fixation. This may be a valuable technique to reduce failure of fixation. Copyright © 2018 Elsevier Inc. All rights reserved.

Percutaneous Intramedullary Screw Fixation of Distal Fibula Fractures: A Case Series and Systematic Review.

PubMed

Loukachov, Vladimir V; Birnie, Merel F N; Dingemans, Siem A; de Jong, Vincent M; Schepers, Tim

The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our study was to provide an overview of the published data regarding intramedullary screw fixation of fibula fractures combined with a small consecutive case series. We performed a search of published studies to identify the studies in which fibula fractures were treated with percutaneous intramedullary screw fixation. Additionally, all consecutive patients treated for an unstable ankle fracture in a level 1 trauma center using an intramedullary screw were retrospectively included. The literature search identified 6 studies with a total of 180 patients. Wound infection was seen in 1 patient (0.6%), anatomic reduction was achieved in 168 patients (93.3%), and a loss of reduction was seen in 2 patients (1.1%). Implant removal was deemed necessary in 3 patients (1.7%) and nonunion was seen is 2 patients (1.1%). A total of 11 patients, in whom no wound complications occurred, were included in our study. The follow-up duration was a minimum of 12 months. A secondary dislocation was seen in 1 patient, and delayed union was observed after 7.5 months in 1 other patient. In conclusion, intramedullary screw fixation is a safe and adequate method to use for fibula fractures, with a low risk of wound complications. Additional research regarding functional outcome is warranted. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Intramedullary nails with two lag screws.

PubMed

Brown, C J; Wang, C J; Yettram, A L; Procter, P

2004-06-01

To investigate the structural integrity of intramedullary nails with two lag screws, and to give guidance to orthopaedic surgeons in the choice of appropriate devices. Alternative designs of the construct are considered, and the use of a slotted upper lag screw insertion hole is analysed. Intramedullary fixation devices with a single lag screw have been known to fail at the lag screw insertion hole. Using two lag screws is considered. It has also been proposed to use a slot in the nail for the upper lag screw to prevent the upper lag screw from sticking. Bending and torsion load cases are analysed using finite element method. Consideration of both load conditions is essential. The results present the overall stiffness of the assembly, the load sharing between lag screws, and the possibility for cut-out to occur. While the slot for the upper lag screw might be advantageous with regard to the stresses in the lag screws, it could be detrimental for cut-out occurring adjacent to the lag screws. Comparative analyses demonstrate that two lag screws may be advantageous in patients whose cancellous bone quality is good and who impose large loads on the lag screw/nail interface. However, the use of two screws might pre-dispose to failure by cut-out of the lag screws. The addition of a slotted hole for the upper lag screw appears to do nothing significant to reduce the risk of such a failure. Copyright 2004 Elsevier Ltd.

Hollow screw-like drill in plasma using an intense Laguerre–Gaussian laser

PubMed Central

Wang, Wenpeng; Shen, Baifei; Zhang, Xiaomei; Zhang, Lingang; Shi, Yin; Xu, Zhizhan

2015-01-01

With the development of ultra-intense laser technology, MeV ions can be obtained from laser–foil interactions in the laboratory. These energetic ion beams can be applied in fast ignition for inertial confinement fusion, medical therapy, and proton imaging. However, these ions are mainly accelerated in the laser propagation direction. Ion acceleration in an azimuthal orientation was scarcely studied. In this research, a doughnut Laguerre–Gaussian (LG) laser is used for the first time to examine laser–plasma interaction in the relativistic intensity regime in three-dimensional particle-in-cell simulations. Studies have shown that a novel rotation of the plasma is produced from the hollow screw-like drill of an mode laser. The angular momentum of particles in the longitudinal direction produced by the LG laser is enhanced compared with that produced by the usual laser pulses, such as linearly and circularly polarized Gaussian pulses. Moreover, the particles (including electrons and ions) can be trapped and uniformly compressed in the dark central minimum of the doughnut LG pulse. The hollow-structured LG laser has potential applications in the generation of x-rays with orbital angular momentum, plasma accelerators, fast ignition for inertial confinement fusion, and pulsars in the astrophysical environment. PMID:25651780

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

PubMed Central

Sun, Haolin; Liu, Chun; Liu, Huiling; Bai, Yanjie; Zhang, Zheng; Li, Xuwen; Li, Chunde; Yang, Huilin; Yang, Lei

2017-01-01

Polymethyl methacrylate (PMMA)-augmented cannulated pedicle-screw fixation has been routinely performed for the surgical treatment of lumbar degenerative diseases. Despite its satisfactory clinical outcomes and prevalence, problems and complications associated with high-strength, stiff, and nondegradable PMMA have largely hindered the long-term efficacy and safety of pedicle-screw fixation in osteoporotic patients. To meet the unmet need for better bone cement for cannulated pedicle-screw fixation, a new injectable and biodegradable nanocomposite that was the first of its kind was designed and developed in the present study. The calcium phosphate-based nanocomposite (CPN) exhibited better anti-pullout ability and similar fluidity and dispersing ability compared to clinically used PMMA, and outperformed conventional calcium phosphate cement (CPC) in all types of mechanical properties, injectability, and biodegradability. In term of axial pullout strength, the CPN-augmented cannulated screw reached the highest force of ~120 N, which was higher than that of PMMA (~100 N) and CPC (~95 N). The compressive strength of the CPN (50 MPa) was three times that of CPC, and the injectability of the CPN reached 95%. In vivo tests on rat femur revealed explicit biodegradation of the CPN and subsequent bone ingrowth after 8 weeks. The promising results for the CPN clearly suggest its potential for replacing PMMA in the application of cannulated pedicle-screw fixation and its worth of further study and development for clinical uses. PMID:28490878

Low Cost Electrode Assembly for EEG Recordings in Mice

PubMed Central

Vogler, Emily C.; Flynn, Daniel T.; Busciglio, Federico; Bohannan, Ryan C.; Tran, Alison; Mahavongtrakul, Matthew; Busciglio, Jorge A.

2017-01-01

Wireless electroencephalography (EEG) of small animal subjects typically utilizes miniaturized EEG devices which require a robust recording and electrode assembly that remains in place while also being well-tolerated by the animal so as not to impair the ability of the animal to perform normal living activities or experimental tasks. We developed simple and fast electrode assembly and method of electrode implantation using electrode wires and wire-wrap technology that provides both higher survival and success rates in obtaining recordings from the electrodes than methods using screws as electrodes. The new wire method results in a 51% improvement in the number of electrodes that successfully record EEG signal. Also, the electrode assembly remains affixed and provides EEG signal for at least a month after implantation. Screws often serve as recording electrodes, which require either drilling holes into the skull to insert screws or affixing screws to the surface of the skull with adhesive. Drilling holes large enough to insert screws can be invasive and damaging to brain tissue, using adhesives may interfere with conductance and result in a poor signal, and soldering screws to wire leads results in fragile connections. The methods presented in this article provide a robust implant that is minimally invasive and has a significantly higher success rate of electrode implantation. In addition, the implant remains affixed and produces good recordings for over a month, while using economical, easily obtained materials and skills readily available in most animal research laboratories. PMID:29184480

Low Cost Electrode Assembly for EEG Recordings in Mice.

PubMed

Vogler, Emily C; Flynn, Daniel T; Busciglio, Federico; Bohannan, Ryan C; Tran, Alison; Mahavongtrakul, Matthew; Busciglio, Jorge A

2017-01-01

Wireless electroencephalography (EEG) of small animal subjects typically utilizes miniaturized EEG devices which require a robust recording and electrode assembly that remains in place while also being well-tolerated by the animal so as not to impair the ability of the animal to perform normal living activities or experimental tasks. We developed simple and fast electrode assembly and method of electrode implantation using electrode wires and wire-wrap technology that provides both higher survival and success rates in obtaining recordings from the electrodes than methods using screws as electrodes. The new wire method results in a 51% improvement in the number of electrodes that successfully record EEG signal. Also, the electrode assembly remains affixed and provides EEG signal for at least a month after implantation. Screws often serve as recording electrodes, which require either drilling holes into the skull to insert screws or affixing screws to the surface of the skull with adhesive. Drilling holes large enough to insert screws can be invasive and damaging to brain tissue, using adhesives may interfere with conductance and result in a poor signal, and soldering screws to wire leads results in fragile connections. The methods presented in this article provide a robust implant that is minimally invasive and has a significantly higher success rate of electrode implantation. In addition, the implant remains affixed and produces good recordings for over a month, while using economical, easily obtained materials and skills readily available in most animal research laboratories.

Oral mucosa tissue response to titanium cover screws.

PubMed

Olmedo, Daniel G; Paparella, María L; Spielberg, Martín; Brandizzi, Daniel; Guglielmotti, María B; Cabrini, Rómulo L

2012-08-01

Titanium is the most widely used metal in dental implantology. The release of particles from metal structures into the biologic milieu may be the result of electrochemical processes (corrosion) and/or mechanical disruption during insertion, abutment connection, or removal of failing implants. The aim of the present study is to evaluate tissue response of human oral mucosa adjacent to titanium cover screws. One hundred fifty-three biopsies of the supra-implant oral mucosa adjacent to the cover screw of submerged dental implants were analyzed. Histologic studies were performed to analyze epithelial and connective tissue as well as the presence of metal particles, which were identified using microchemical analysis. Langerhans cells, macrophages, and T lymphocytes were studied using immunohistochemical techniques. The surface of the cover screws was evaluated by scanning electron microscopy (SEM). Forty-one percent of mucosa biopsies exhibited metal particles in different layers of the section thickness. Particle number and size varied greatly among specimens. Immunohistochemical study confirmed the presence of macrophages and T lymphocytes associated with the metal particles. Microchemical analysis revealed the presence of titanium in the particles. On SEM analysis, the surface of the screws exhibited depressions and irregularities. The biologic effects seen in the mucosa in contact with the cover screws might be associated with the presence of titanium or other elements, such as aluminum or vanadium. The potential long-term biologic effects of particles on soft tissues adjacent to metallic devices should be further investigated because these effects might affect the clinical outcome of the implant.

Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation.

PubMed

Leblanc, E; Bellemore, J M; Cheng, T; Little, D G; Birke, O

2017-04-01

Slipped capital femoral epiphysis (SCFE) is a deformity of the proximal femur secondary to widened and unstable physis. In stabilising the slip, gold standard treatments stop growth and involve premature physeal closure, which prevents the remodelling of the acquired deformity and creates a leg length discrepancy that may be significant in younger patients. We measured the impact of placing threaded screws across the proximal femoral physis by measuring the centre-trochanteric distance (CTD) and articulo-trochanteric distance (ATD) in participants with or without prophylactic fixation. We then compared the mechanical performance of static (stainless and titanium cannulated Synthes screws) and potentially growing implants (Synthes SCFE screw and Pega Medical Free Gliding screw) in a validated synthetic bone model. In the review of 30 non-fixed and 60 fixated hips over a mean follow-up of 1.9 years, we have noted a significant difference in pre/post CTD and ATD, as well as the change in CTD and ATD over time. In the biomechanical study, the newer implants allowing growth (Synthes SCFE screw and Pega Medical Free Gliding screw) were both shown to be at least non-inferior. The primary deformity of a SCFE in itself alters hip mechanics. Also, as confirmed in this study, there is a secondary deformity that is created by static fixation and relative trochanteric overgrowth. To help remodel mild deformities and prevent secondary trochanteric overgrowth, growing implants seem to be non-inferior to the more standard means of fixation in static testing.

Investigating the Use of Polymeric Binders in Twin Screw Melt Granulation Process for Improving Compactibility of Drugs.

PubMed

Batra, Amol; Desai, Dipen; Serajuddin, Abu T M

2017-01-01

Traditionally, the melt granulation for pharmaceutical products was performed at low temperature (<90°C) with high-shear granulators using low-melting waxy binders, and tablets produced using such granules were not amenable to large-scale manufacturing. The situation has changed in recent years by the use of twin screw extruder where the processing temperature could be increased to as high as 180°C and polymers with high T g could be used as binders. In this study, different polymeric binders were screened for their suitability in improving compactibility of 2 drugs, metformin hydrochloride and acetaminophen, by twin screw melt granulation. Processing temperatures for the 2 drugs were set at 180°C and 130°C, respectively. Screw configuration, screw speed, and feed rate were optimized such that all polymeric binders used produced granules. Several hydroxypropyl cellulose, hydroxypropyl methylcellulose, polyvinylpyrrolidone, and methacrylate-based polymers, including Klucel ® EXF, Eudragit ® EPO, and Soluplus ® , demonstrated good tablet tensile strength (>2 MPa) when granules were produced using only 10% wt/wt polymer concentration. Certain polymers provided acceptable compactibility even at 5% wt/wt. Thus, twin screw melt granulation process may be used with different polymers at a wide range of temperature. Due to low excipient concentration, this granulation method is especially suitable for high-dose tablets. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Hollow Abutment Screw Design for Easy Retrieval in Case of Screw Fracture in Dental Implant System.

PubMed

Sim, Bo Kyun; Kim, Bongju; Kim, Min Jeong; Jeong, Guk Hyun; Ju, Kyung Won; Shin, Yoo Jin; Kim, Man Yong; Lee, Jong-Ho

2017-01-01

The prosthetic component of dental implant is attached on the abutment which is connected to the fixture with an abutment screw. The abutment screw fracture is not frequent; however, the retrieval of the fractured screw is not easy, and it poses complications. A retrieval kit was developed which utilizes screw removal drills to make a hole on the fractured screw that provides an engaging drill to unscrew it. To minimize this process, the abutment screw is modified with a prefabricated access hole for easy retrieval. This study aimed to introduce this modified design of the abutment screw, the concept of easy retrieval, and to compare the mechanical strengths of the conventional and hollow abutment screws by finite element analysis (FEA) and mechanical test. In the FEA results, both types of abutment screws showed similar stress distribution in the single artificial tooth system. A maximum load difference of about 2% occurred in the vertical load by a mechanical test. This study showed that the hollow abutment screw may be an alternative to the conventional abutment screws because this is designed for easy retrieval and that both abutment screws showed no significant difference in the mechanical tests and in the FEA.

Ball Screw Actuator Including a Compliant Ball Screw Stop

NASA Technical Reports Server (NTRS)

Wingett, Paul T. (Inventor); Hanlon, Casey (Inventor)

2015-01-01

An actuator includes a ball nut, a ball screw, and a ball screw stop. The ball nut is adapted to receive an input torque and in response rotates and supplies a drive force. The ball screw extends through the ball nut and has a first end and a second end. The ball screw receives the drive force from the ball nut and in response selectively translates between a retract position and a extend position. The ball screw stop is mounted on the ball screw proximate the first end to translate therewith. The ball screw stop engages the ball nut when the ball screw is in the extend position, translates, with compliance, a predetermined distance toward the first end upon engaging the ball nut, and prevents further rotation of the ball screw upon translating the predetermined distance.

Ball Screw Actuator Including a Compliant Ball Screw Stop

NASA Technical Reports Server (NTRS)

Wingett, Paul T. (Inventor); Hanlon, Casey (Inventor)

2017-01-01

An actuator includes a ball nut, a ball screw, and a ball screw stop. The ball nut is adapted to receive an input torque and in response rotates and supplies a drive force. The ball screw extends through the ball nut and has a first end and a second end. The ball screw receives the drive force from the ball nut and in response selectively translates between a retract position and a extend position. The ball screw stop is mounted on the ball screw proximate the first end to translate therewith. The ball screw stop engages the ball nut when the ball screw is in the extend position, translates, with compliance, a predetermined distance toward the first end upon engaging the ball nut, and prevents further rotation of the ball screw upon translating the predetermined distance.

Anatomic parameters of the sacral lamina for osteosynthesis in transverse sacral fractures.

PubMed

Katsuura, Yoshihiro; Lorenz, Eileen; Gardner, Warren

2018-05-01

To analyze the morphometric parameters of the dorsal sacral lamina and pedicles to determine if there is adequate bony architecture to support plate osteosynthesis. Two reviewers performed measurements on 98 randomly selected high-resolution CT scans of the pelvis to quantify the bony anatomy of the sacral lamina. Measurements included the depths of the lamina at each sacral level, the trajectory and depth of the sacral pedicles from the sacral lamina, and the width of the sacral canal. A bone mineral density analysis was performed on the sacral lamina using Hounsfield units (HU) and compared to the L1 and S1 vertebral bodies. The sacral lamina were found to form peaks and troughs which we refered to as major and minor sections. On average, the thickness was > 4 mm at all major screw starting points, indicating adequate geometry for screw fixation. The sacral pedicle depths were 27, 18, 16, and 14 mm at S2-S5, respectively. The average angulation from midline of this screw path directed laterally to avoid the sacral canal was 20°, 17°, 8°, and - 8° for the S2-5 pedicles, respectively. Average sacral canal diameter was 11 mm for S2 and 8 mm for S3-5. The sacral lamina had an average bone mineral density of 635 HU, which was significantly different from the density of the L5 (220 HU) and S1 (165 HU) vertebral bodies (p < 0.005). This morphometric data was used to pilot a new plating technique. The sacral lamina offers a novel target for screw fixation and meets the basic geometric and compositional criteria for screw purchase. To our knowledge, this study represents the first morphometric analysis performed on the sacral lamina and pedicles for plate application.

Desktop-based computer-assisted orthopedic training system for spinal surgery.

PubMed

Rambani, Rohit; Ward, James; Viant, Warren

2014-01-01

Simulation and surgical training has moved on since its inception during the end of the last century. The trainees are getting more exposed to computers and laboratory training in different subspecialties. More needs to be done in orthopedic simulation in spinal surgery. To develop a training system for pedicle screw fixation and validate its effectiveness in a cohort of junior orthopedic trainees. Fully simulated computer-navigated training system is used to train junior orthopedic trainees perform pedicle screw insertion in the lumbar spine. Real patient computed tomography scans are used to produce the real-time fluoroscopic images of the lumbar spine. The training system was developed to simulate pedicle screw insertion in the lumbar spine. A total of 12 orthopedic senior house officers performed pedicle screw insertion in the lumbar spine before and after the training on training system. The results were assessed based on the scoring system, which included the amount of time taken, accuracy of pedicle screw insertion, and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation, and the number of exposures after the training on simulator system. This was statistically significant using paired Student t test (p < 0.05). Fully simulated computer-navigated training system is an efficient training tool for young orthopedic trainees. This system can be used to augment training in the operating room, and trainees acquire their skills in the comfort of their study room or in the training room in the hospital. The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Ultrasound melted polymer sleeve for improved screw anchorage in trabecular bone--A novel screw augmentation technique.

PubMed

Schmoelz, W; Mayr, R; Schlottig, F; Ivanovic, N; Hörmann, R; Goldhahn, J

2016-03-01

Screw anchorage in osteoporotic bone is still limited and makes treatment of osteoporotic fractures challenging for surgeons. Conventional screws fail in poor bone quality due to loosening at the screw-bone interface. A new technology should help to improve this interface. In a novel constant amelioration process technique, a polymer sleeve is melted by ultrasound in the predrilled screw hole prior to screw insertion. The purpose of this study was to investigate in vitro the effect of the constant amelioration process platform technology on primary screw anchorage. Fresh frozen femoral heads (n=6) and vertebrae (n=6) were used to measure the maximum screw insertion torque of reference and constant amelioration process augmented screws. Specimens were cut in cranio-caudal direction, and the screws (reference and constant amelioration process) were implanted in predrilled holes in the trabecular structure on both sides of the cross section. This allowed the pairwise comparison of insertion torque for constant amelioration process and reference screws (femoral heads n=18, vertebrae n=12). Prior to screw insertion, a micro-CT scan was made to ensure comparable bone quality at the screw placement location. The mean insertion torque for the constant amelioration process augmented screws in both, the femoral heads (44.2 Ncm, SD 14.7) and the vertebral bodies (13.5 Ncm, SD 6.3) was significantly higher than for the reference screws of the femoral heads (31.7 Ncm, SD 9.6, p<0.001) and the vertebral bodies (7.1 Ncm, SD 4.5, p<0.001). The interconnection of the melted polymer sleeve with the surrounding trabecular bone in the constant amelioration process technique resulted in a higher screw insertion torque and can improve screw anchorage in osteoporotic trabecular bone. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis.

PubMed

Zhao, Y; Zhang, S; Sun, T; Wang, D; Lian, W; Tan, J; Zou, D; Zhao, Y

2013-09-01

To compare the stability of lengthened sacroiliac screw and standard sacroiliac screw for the treatment of unilateral vertical sacral fractures; to provide reference for clinical applications. A finite element model of Tile type C pelvic ring injury (unilateral Denis type II fracture of the sacrum) was produced. The unilateral sacral fractures were fixed with lengthened sacroiliac screw and sacroiliac screw in six different types of models respectively. The translation and angle displacement of the superior surface of the sacrum (in standing position on both feet) were measured and compared. The stability of one lengthened sacroiliac screw fixation in S1 or S2 segment is superior to that of one sacroiliac screw fixation in the same sacral segment. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one sacroiliac screw fixation in S1 and S2 segments respectively. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one lengthened sacroiliac screw fixation in S1 or S2 segment. The stability of one sacroiliac screw fixation in S1 and S2 segments respectively is markedly superior to that of one sacroiliac screw fixation in S1 or S2 segment. The vertical and rotational stability of lengthened sacroiliac screw fixation and sacroiliac screw fixation in S2 is superior to that of S1. In a finite element model of type C pelvic ring disruption, S1 and S2 lengthened sacroiliac screws should be utilized for the fixation as regularly as possible and the most stable fixation is the combination of the lengthened sacroiliac screws of S1 and S2 segments. Even if lengthened sacroiliac screws cannot be systematically used due to specific conditions, one sacroiliac screw fixation in S1 and S2 segments respectively is recommended. No matter which kind of sacroiliac screw is used, if only one screw can be implanted, the fixation in S2 segment is more recommended than that in S1. Experimental study Level III. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Surgical strategies to improve fixation in the osteoporotic spine: the effects of tapping, cement augmentation, and screw trajectory.

PubMed

Kuhns, Craig A; Reiter, Michael; Pfeiffer, Ferris; Choma, Theodore J

2014-02-01

Study Design Biomechanical study of pedicle screw fixation in osteoporotic bone. Objective To investigate whether it is better to tap or not tap osteoporotic bone prior to placing a cement-augmented pedicle screw. Methods Initially, we evaluated load to failure of screws placed in cancellous bone blocks with or without prior tapping as well as after varying the depths of tapping prior to screw insertion. Then we evaluated load to failure of screws placed in bone block models with a straight-ahead screw trajectory as well as with screws having a 23-degree cephalad trajectory (toward the end plate). These techniques were tested with nonaugmented (NA) screws as well as with bioactive cement (BioC) augmentation prior to screw insertion. Results In the NA group, pretapping decreased fixation strength in a dose-dependent fashion. In the BioC group, the tapped screws had significantly greater loads to failure (p < 0.01). Comparing only the screw orientation, the screws oriented at 23 degrees cephalad had a significantly higher failure force than their respective counterparts at 0 degrees (p < 0.01). Conclusions Standard pedicle screw fixation is often inadequate in the osteoporotic spine, but this study suggests tapping prior to cement augmentation will substantially improve fixation when compared with not tapping. Angulating screws more cephalad also seems to enhance aging spine fixation.

Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes.

PubMed

Kennon, Justin C; Lu, Caroline; McGee-Lawrence, Meghan E; Crosby, Lynn A

2017-06-01

Reverse total shoulder arthroplasty (RTSA) is a viable treatment option for rotator cuff tear arthropathy but carries a complication risk of scapular fracture. We hypothesized that using screws above the central glenoid axis for metaglene fixation creates a stress riser contributing to increased scapula fracture incidence. Clinical type III scapular fracture incidence was determined with screw placement correlation: superior screw vs. screws placed exclusively below the glenoid midpoint. Cadaveric RTSA biomechanical modeling was employed to analyze scapular fractures. We reviewed 318 single-surgeon single-implant RTSAs with screw correlation to identify type III scapular fractures. Seventeen cadaveric scapula specimens were matched for bone mineral density, metaglenes implanted, and fixation with 2 screw configurations: inferior screws alone (group 1 INF ) vs. inferior screws with one additional superior screw (group 2 SUP ). Biomechanical load to failure was analyzed. Of 206 patients, 9 (4.4%) from the superior screw group experienced scapula fractures (type III); 0 fractures (0/112; 0%) were identified in the inferior screw group. Biomechanically, superior screw constructs (group 2 SUP ) demonstrated significantly (P < .05) lower load to failure (1077 N vs. 1970 N) compared with constructs with no superior screws (group 1 INF ). There was no significant age or bone mineral density discrepancy. Clinical scapular fracture incidence significantly decreased (P < .05) for patients with no screws placed above the central cage compared with patients with superior metaglene screws. Biomechanical modeling demonstrates significant construct compromise when screws are used above the central cage, fracturing at nearly half the ultimate load of the inferior screw constructs. We recommend use of inferior screws, all positioned below the central glenoid axis, unless necessary to stabilize the metaglene construct. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Quantitative analysis of titanium-induced artifacts and correlated factors during micro-CT scanning.

PubMed

Li, Jun Yuan; Pow, Edmond Ho Nang; Zheng, Li Wu; Ma, Li; Kwong, Dora Lai Wan; Cheung, Lim Kwong

2014-04-01

To investigate the impact of cover screw, resin embedment, and implant angulation on artifact of microcomputed tomography (micro-CT) scanning for implant. A total of twelve implants were randomly divided into 4 groups: (i) implant only; (ii) implant with cover screw; (iii) implant with resin embedment; and (iv) implants with cover screw and resin embedment. Implants angulation at 0°, 45°, and 90° were scanned by micro-CT. Images were assessed, and the ratio of artifact volume to total volume (AV/TV) was calculated. A multiple regression analysis in stepwise model was used to determine the significance of different factors. One-way ANOVA was performed to identify which combination of factors could minimize the artifact. In the regression analysis, implant angulation was identified as the best predictor for artifact among the factors (P < 0.001). Resin embedment also had significant effect on artifact volume (P = 0.028), while cover screw had not (P > 0.05). Non-embedded implants with the axis parallel to X-ray source of micro-CT produced minimal artifact. Implant angulation and resin embedment affected the artifact volume of micro-CT scanning for implant, while cover screw did not. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Iliac screw for reconstructing posterior pelvic ring in Tile type C1 pelvic fractures.

PubMed

Li, Yonggang; Sang, Xiguang; Wang, Zhiyong; Cheng, Lin; Liu, Hao; Qin, Tao; Di, Kai

2018-06-18

It is often difficult to achieve stable fixation in Tile type C1 pelvic fractures and there is no standard fixation technique for these types of injuries. Iliac screw fixation can be used for treating Type C1 pelvic fractures. A retrospective review was performed on 47 patients who underwent iliac screw fixation in posterior column of ilium (PCI) for Tile type C1 pelvic fractures from July 2007 to December 2014. All patients were treated with fracture reduction, sacral nerve root decompression (if needed), internal fixation by iliac screw and connecting rod. The data on surgical time, intraoperative bleeding volume, postoperative neurologic functions and postoperative complications were analyzed. Patients were follow-up for at least 12months. The mean surgical time was 148minutes, and the mean intraoperative bleeding volume was 763ml. Patients were encouraged in-bed activities immediately after surgery. The postoperative Majeed functional score was 48-100 points (mean 80.2), corresponding to an excellent and good recovery of 91.5%. Postoperative X-radiographs and CT scans indicated satisfactory fracture reduction. Iliac screw fixation combined with sacral nerve canal decompression could effectively restore pelvic alignment and improve neurological functions for complex pelvic trauma. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Hollow Abutment Screw Design for Easy Retrieval in Case of Screw Fracture in Dental Implant System

PubMed Central

Kim, Bongju; Shin, Yoo Jin

2017-01-01

The prosthetic component of dental implant is attached on the abutment which is connected to the fixture with an abutment screw. The abutment screw fracture is not frequent; however, the retrieval of the fractured screw is not easy, and it poses complications. A retrieval kit was developed which utilizes screw removal drills to make a hole on the fractured screw that provides an engaging drill to unscrew it. To minimize this process, the abutment screw is modified with a prefabricated access hole for easy retrieval. This study aimed to introduce this modified design of the abutment screw, the concept of easy retrieval, and to compare the mechanical strengths of the conventional and hollow abutment screws by finite element analysis (FEA) and mechanical test. In the FEA results, both types of abutment screws showed similar stress distribution in the single artificial tooth system. A maximum load difference of about 2% occurred in the vertical load by a mechanical test. This study showed that the hollow abutment screw may be an alternative to the conventional abutment screws because this is designed for easy retrieval and that both abutment screws showed no significant difference in the mechanical tests and in the FEA. PMID:29065610

Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures.

PubMed

Switaj, Paul J; Wetzel, Robert J; Jain, Neel P; Weatherford, Brian M; Ren, Yupeng; Zhang, Li-Qun; Merk, Bradley R

2016-09-01

Fractures in osteoporotic patients can be difficult to treat because of poor bone quality and inability to gain screw purchase. The purpose of this study is to compare modern lateral periarticular distal fibula locked plating to antiglide plating in the setting of an osteoporotic, unstable distal fibula fracture. AO/OTA 44-B2 distal fibula fractures were created in sixteen paired fresh frozen cadaveric ankles and fixed with a lateral locking plate and an independent lag screw or an antiglide plate with a lag screw through the plate. The specimens underwent stiffness, cyclic loading, and load to failure testing. The energy absorbed until failure, torque to failure, construct stiffness, angle at failure, and energy at failure was recorded. The lateral locking construct had a higher torque to failure (p=0.02) and construct stiffness (p=0.04). The locking construct showed a trend toward increased angle at failure, but did not reach statistical significance (p=0.07). Seven of the eight lateral locking plate specimens failed through the distal locking screws, while the antiglide plating construct failed with pullout of the distal screws and displacement of the fracture in six of the eight specimens. In our study, the newly designed distal fibula periarticular locking plate with increased distal fixation is biomechanically stronger than a non-locking one third tubular plate applied in antiglide fashion for the treatment of AO/OTA 44-B2 osteoporotic distal fibula fractures. V: This is an ex-vivo study performed on cadavers and is not a study performed on live patients. Therefore, this is considered Level V evidence. Copyright © 2015. Published by Elsevier Ltd.

Atlas instrumentation guided by the medial edge of the posterior arch: An anatomic and radiologic study.

PubMed

Al-Habib, Amro F; Al-Rabie, Abdulkarim; Aleissa, Sami; Albakr, Abdulrahman; Abobotain, Abdulaziz

2017-01-01

This was an interventional human cadaver study and radiological study. Atlas instrumentation is frequently involved in fusion procedures involving the craniocervical junction area. Identification of the entry point at the center of atlas lateral mass (ALM) is challenging because of its rounded posterior surface and the surrounding venous plexus. This report examines using the medial edge of atlas posterior arch (MEC1) as a fixed and reliable anatomic reference to guide the entry point of ALM screws. Fifty, normal, cervical spine computed tomography studies were reviewed. ALM screw trajectories were planned at one point along MEC1 and another point 2 mm lateral to MEC1. Free-hand ALM instrumentation was performed in ten fresh human cadavers using the 2 mm entry point, with a sagittal trajectory parallel to atlas inferior arch (IAC1); three-dimensional imaging was then performed to confirm instrumentation accuracy. The average ALM diameter was 12.35 mm. Inserting a screw using the entry point 2 mm lateral to MEC1 was closer to ALM midpoint than using the entry point along MEC1 ( P < 0.0001). Twenty ALM screws were successfully inserted in the ten cadavers. No encroachments into the spinal canal or foramen transversarium occurred. However, two screws were superiorly directed and violated the occipitocervical joint; they were not parallel to IAC1. MEC1 provides a fixed and reliable landmark for ALM instrumentation. An entry point 2 mm point lateral to MEC1 is close to ALM midpoint. IAC1 also provides a guide for the sagittal trajectory. Attention to anatomic landmarks may help reduce complications associated with atlas instrumentation but should be verified in future clinical studies.

A comparison of preload values in gold and titanium dental implant retaining screws.

PubMed

Doolabh, R; Dullabh, H D; Sykes, L M

2014-08-01

This in vitro investigation compared the effect of using either gold or titanium retaining screws on preload in the dental implant- abutment complex. Inadequate preload can result in screw loosening, whilst fracture may occur if preload is excessive. These are the most commonly reported complications in implant-retained prostheses, and result in unscheduled, costly and time-consuming visits for the patient and the clinician. This study investigated changes in preload generation after repeated torque applications to gold and titanium screws. The test set-up consisted of an implant body, a cylindrical transmucosa abutment, and the test samples of gold and of titanium retaining screws. The implant bodies were anchored using a load cell, and the transmucosal abutments were attached using either gold or titanium retaining screws. A torque gauge was used to apply torque of 20Ncm, 32Ncm, and 40Ncm to the retaining screws. The preloads generated in each screw type were compared at each torque setting, and after repeated tightening episodes. In addition, the effect of applying torque beyond the manufacturers' recommendations was also examined. Gold retaining screws were found to achieve consistently higher preload values than titanium retaining screws. Preload values were not significantly different from the first to the tenth torque cycle. Titanium screws showed more consistent preload values, albeit lower than those of the gold screws. However due to possible galling of the internal thread of the implant body by titanium screws, gold screws remain the retaining screw of choice. Based on the findings of this study, gold retaining screws generate better preload than titanium. Torque beyond the manufacturers' recommendations resulted in a more stable implant complex. However, further investigations, with torque applications repeated until screw breakage, are needed to advise on ideal maintenance protocols.

Biomechanical Comparison of Inter-fragmentary Compression Pressures: Lag Screw versus Herbert Screw for Anterior Odontoid Screw Fixation.

PubMed

Park, Jin-Woo; Kim, Kyoung-Tae; Sung, Joo-Kyung; Park, Seong-Hyun; Seong, Ki-Woong; Cho, Dae-Chul

2017-09-01

The purpose of the present study was to compare inter-fragmentary compression pressures after fixation of a simulated type II odontoid fracture with the headless compression Herbert screw and a half threaded cannulated lag screw. We compared inter-fragmentary compression pressures between 40- and 45-mm long 4.5-mm Herbert screws (n=8 and n=9, respectively) and 40- and 45-mm long 4.0-mm cannulated lag screws (n=7 and n=10, respectively) after insertion into rigid polyurethane foam test blocks (Sawbones, Vashon, WA, USA). A washer load cell was placed between the two segments of test blocks to measure the compression force. Because the total length of each foam block was 42 mm, the 40-mm screws were embedded in the cancellous foam, while the 45-mm screws penetrated the denser cortical foam at the bottom. This enabled us to compare inter-fragmentary compression pressures as they are affected by the penetration of the apical dens tip by the screws. The mean compression pressures of the 40- and 45-mm long cannulated lag screws were 50.48±1.20 N and 53.88±1.02 N, respectively, which was not statistically significant (p=0.0551). The mean compression pressures of the 40-mm long Herbert screw was 52.82±2.17 N, and was not statistically significant compared with the 40-mm long cannulated lag screw (p=0.3679). However, 45-mm Herbert screw had significantly higher mean compression pressure (60.68±2.03 N) than both the 45-mm cannulated lag screw and the 40-mm Herbert screw (p=0.0049 and p=0.0246, respectively). Our results showed that inter-fragmentary compression pressures of the Herbert screw were significantly increased when the screw tip penetrated the opposite dens cortical foam. This can support the generally recommended surgical technique that, in order to facilitate maximal reduction of the fracture gap using anterior odontoid screws, it is essential to penetrate the apical dens tip with the screw.

Paradoxical tunnel enlargement after ACL reconstruction with hamstring autografts when using β-TCP containing interference screws for tibial aperture fixation- prospectively comparative study.

PubMed

Wang, Joon Ho; Lee, Eun Su; Lee, Byung Hoon

2017-09-16

Tibial aperture fixation with a bioabsorbable interference screw is a popular fixation method in anterior cruciate ligament reconstruction (ACLR). An interference screw containing β-tricalcium phosphate (β-TCP) to improve bony integration and biocompatibility was recently introduced. This study aims to compare the clinical outcomes and radiological results of tunnel enlargement effect between the 2 bioabsorbable fixative devices of pure poly-L-lactic acid (PLLA) interference screws and β-TCP-containing screws, for tibial interference fixation in ACLR using hamstring autografts. Eighty consecutive patients who had undergone double-bundle ACLR between 2011 to 2012 were prospectively reviewed and randomly divided into two groups based on the type of tibial interference screw: 28 were assigned to the pure PLLA screw group (Group A), while the other 29 were assigned to the β-TCP-containing screw fixation group (Group B). Clinical evaluations and radiological analyses were conducted in both groups with a minimum 2- year follow-up. There was no significant difference in subjective or objective clinical outcome between the 2 groups. In radiological analyses, the use of a β-TCP-containing screw reduced tunnel widening in the portion of the tunnel with screw engagement compared to the pure PLLA screw, while the use of a β-TCP-containing screw resulted in greater tunnel enlargement in the proximal portion of the tunnel without screw engagement than use of a pure PLLA screw. Use of a β-TCP-containing interference screw in tibial aperture fixation reduced tunnel enlargement in the vicinity of the screw, whereas greater enlargement occurred proximal to the screw end relative to use of a pure PLLA interference screw. These paradoxical enlargements in use of β-TCP containing screws suggest that for reducing tunnel enlargement, the length of the interference screw should be as fit as possible with tunnel length in terms of using soft grafts. II, Prospectively comparative study. Retrospectively registered with ClinicalTrials.gov. (NCT02754674) , Date of trial registration: February 10, 2016.

[Use of pedicle percutaneous cemented screws in the management of patients with poor bone stock].

PubMed

Pesenti, S; Graillon, T; Mansouri, N; Adetchessi, T; Tropiano, P; Blondel, B; Fuentes, S

2016-12-01

Management of patients with poor bone stock remains difficult due to the risks of mechanical complications such as screws pullouts. At the same time, development of minimal invasive spinal techniques using a percutaneous approach is greatly adapted to these fragile patients with a reduction in operative time and complications. The aim of this study was to report our experience with cemented percutaneous screws in the management of patients with a poor bone stock. Thirty-five patients were included in this retrospective study. In each case, a percutaneous osteosynthesis using cemented screws was performed. Indications were osteoporotic fractures, metastasis or fractures on ankylosing spine. Depending on radiologic findings, short or long constructs (2 levels above and below) were performed and an anterior column support (kyphoplasty or anterior approach) was added. Evaluation of patients was based on pre and postoperative CT-scans associated with clinical follow-up with a minimum of 6 months. Eleven men and 24 women with a mean age of 73 years [60-87] were included in the study. Surgical indication was related to an osteoporotic fracture in 20 cases, a metastasis in 13 cases and a fracture on ankylosing spine in the last 2 cases. Most of the fractures were located between T10 and L2 and a long construct was performed in 22 cases. Percutaneous kyphoplasty was added in 24 cases and a complementary anterior approach in 3 cases. Average operative time was 86minutes [61-110] and blood loss was estimated as minor in all the cases. In the entire series, average volume of cement injected was 1.8 cc/screw. One patient underwent a major complication with a vascular leakage responsible for a cement pulmonary embolism. With a 9 months average follow-up [6-20], no cases of infection or mechanical complication was reported. Minimal invasive spinal techniques are greatly adapted to the management of fragile patients. The use of percutaneous cemented screws is, in our experience, a valuable alternative for spinal fixation in patients with poor bone stock. This technique allows a good bony fixation with a low rate of complications. However, rigorous preoperative planning is necessary in order to avoid complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Design of Minimal Invasive Screw on Posterior Pelvis Ring and Pelvic Finite Element Analysis].

PubMed

Tang, Fan; Min, Li; Wang, Yan-Ling; Qu, Bo; Zhou, Yong; Luo, Yi; Zhang, Wen-Li; Shi, Rui; Duan, Hong; Tu, Chong-Qi

2017-09-01

To design minimal invasive screw on posterior pelvic ring and perform threedimensional finite element analysis based on a pelvis finite element model. We measured the pelvic anatomical data of 20 healthy volunteers and identified potential designs for minimal invasive screw on posterior pelvic ring. A finite element model of pelvis was then established. Threedimensional finite element analyses were performed under static and dynamic mechanical loading,respectively. Three screw tracks on ilium (A,B and C) were identified based on a threedimensional reconstruction of pelvis. Nail track B and C had greater length and width,but shorter distance between nailing and soft tissue compared with nail track A. Static loading under an external rotation load of 500 N generated a maximum Mises Von stress of 582.05 Pa and sacral iliac complex of 107.38 Pa. The greatest strain was located at the articular cartilage on the side of the nail,followed by lateral sacral joint cartilage and symphysis pubis. The largest displacement was located at the ilium on the side of the nail,with a gradient decrease to the opposite side. The largest displacement of the anterior superior iliac spine was 0.35 cm on the side of the nail. The dynamic loading identified displacement of the anterior superior iliac spine with 1.5 mm in Z axis,1.8 mm in X axis and -0.2 mm in Y axis; and displacement of the pubic bone with 0.8 mm in Z axis,1.0 mm in X axis and 0.03 mm in Y axis. The maximum displacement appeared along the impact direction: Y axis. Relatively large equivalent stress was found in pubis and ischium,anterior superior iliac spine,sacrum,acetabular that are prone to fracture. With increased impact force,the stress of pelvis increased over time. The maximum impact force,stress and displacement of the pelvis occurred at 10 ms when peak force was reached. Under the impact of 4 000 N and 5 000 N,the bone was subject to a stress level of over 200 MPa,exceeding its average yield strength,which suggests a possibility of pelvic fracture. Taking B/C as a main screw track and A as an auxiliary screw track is a reasonable choice. The pelvic finite element model lays a foundation for further studies into sacral fracture and design of screw tracks.

A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic pedicle screws.

PubMed

Abe, Yuichiro; Ito, Manabu; Abumi, Kuniyoshi; Kotani, Yoshihisa; Sudo, Hideki; Minami, Akio

2011-11-01

Use of computer-assisted spine surgery (CASS) technologies, such as navigation systems, to improve the accuracy of pedicle screw (PS) placement is increasingly popular. Despite of their benefits, previous CASS systems are too expensive to be ubiquitously employed, and more affordable and portable systems are desirable. The aim of this study was to introduce a novel and affordable computer-assisted technique that 3-dimensionally visualizes anatomical features of the pedicles and assists in PS insertion. The authors have termed this the 3D-visual guidance technique for inserting pedicle screws (3D-VG TIPS). The 3D-VG technique for placing PSs requires only a consumer-class computer with an inexpensive 3D DICOM viewer; other special equipment is unnecessary. Preoperative CT data of the spine were collected for each patient using the 3D-VG TIPS. In this technique, the anatomical axis of each pedicle can be analyzed by volume-rendered 3D models, as with existing navigation systems, and both the ideal entry point and the trajectory of each PS can be visualized on the surface of 3D-rendered images. Intraoperative guidance slides are made from these images and displayed on a TV monitor in the operating room. The surgeon can insert PSs according to these guidance slides. The authors enrolled 30 patients with adolescent idiopathic scoliosis (AIS) who underwent posterior fusion with segmental screw fixation for validation of this technique. The novel technique allowed surgeons, from office or home, to evaluate the precise anatomy of each pedicle and the risks of screw misplacement, and to perform 3D preoperative planning for screw placement on their own computer. Looking at both 3D guidance images on a TV monitor and the bony structures of the posterior elements in each patient in the operating theater, surgeons were able to determine the best entry point for each PS with ease and confidence. Using the current technique, the screw malposition rate was 4.5% in the thoracic region in corrective surgery for AIS. The authors found that 3D-VG TIPS worked on a consumer-class computer and easily visualized the ideal entry point and trajectory of PSs in any operating theater without costly special equipment. This new technique is suitable for preoperative planning and intraoperative guidance when performing reconstructive surgery with PSs.

Testing Pullout Strength of Pedicle Screw Using Synthetic Bone Models: Is a Bilayer Foam Model a Better Representation of Vertebra?

PubMed

Varghese, Vicky; Krishnan, Venkatesh; Saravana Kumar, Gurunathan

2018-06-01

A biomechanical study. A new biomechanical model of the vertebra has been developed that accounts for the inhomogeneity of bone and the contribution of the pedicle toward the holding strength of a pedicle screw. Pullout strength studies are typically carried out on rigid polyurethane foams that represent the homogeneous vertebral framework of the spine. However, the contribution of the pedicle region, which contributes to the inhomogeneity in this framework, has not been considered in previous investigations. Therefore, we propose a new biomechanical model that can account for the vertebral inhomogeneity, especially the contribution of the pedicles toward the pullout strength of the pedicle screw. A bilayer foam model was developed by joining two foams representing the pedicle and the vertebra. The results of the pullout strength tests performed on the foam models were compared with those from the tests performed on the cadaver lumbar vertebra. Significant differences ( p <0.05) were observed between the pullout strength of the pedicle screw in extremely osteoporotic (0.18±0.11 kN), osteoporotic (0.37±0.14 kN), and normal (0.97±0.4 kN) cadaver vertebra. In the monolayer model, significant differences ( p <0.05) were observed in pullout strength between extremely osteoporotic (0.3±0.02 kN), osteoporotic (0.65±0.12 kN), and normal (0.99±0.04 kN) bone model. However, the bilayer foam model exhibited no significant differences ( p >0.05) in the pullout strength of pedicle screws between osteoporotic (0.85±0.08 kN) and extremely osteoporotic bone models (0.94±0.08 kN), but there was a significant difference ( p <0.05) between osteoporotic (0.94±0.08 kN) and normal bone models (1.19±0.05 kN). There were no significant differences ( p >0.05) in pullout strength between cadaver and bilayer foam model in normal bones. The new synthetic bone model that reflects the contribution of the pedicles to the pullout strength of the pedicle screws could provide a more efficacious means of testing pedicle-screw pullout strength. The bilayer model can match the pullout strength value of normal lumbar vertebra bone whereas the monolayer foam model was able to match that of the extremely osteoporotic lumbar vertebra.

A comparison of screw insertion torque and pullout strength.

PubMed

Ricci, William M; Tornetta, Paul; Petteys, Timothy; Gerlach, Darin; Cartner, Jacob; Walker, Zakiyyah; Russell, Thomas A

2010-06-01

Pullout strength of screws is a parameter used to evaluate plate screw fixation strength. However, screw fixation strength may be more closely related to its ability to generate sufficient insertion because stable nonlocked plate-screw fracture fixation requires sufficient compression between plate and bone such that no motion occurs between the plate and bone under physiological loads. Compression is generated by tightening of screws. In osteoporotic cancellous bone, sufficient screw insertion torque may not be generated before screw stripping. The effect of screw thread pitch on generation of maximum insertion torque (MIT) and pullout strength (POS) was investigated in an osteoporotic cancellous bone model and the relationship between MIT and POS was analyzed. Stainless steel screws with constant major (5.0 mm) and minor (2.7 mm) diameters but with varying thread pitches (1, 1.2, 1.5, 1.6, and 1.75 mm) were tested for MIT and POS in a validated osteoporotic surrogate for cancellous bone (density of 160 kg/m(3) [10 lbs/ft(3)]). MIT was measured with a torque-measuring hex driver for screws inserted through a one-third tubular plate. POS was measured after insertion of screws to a depth of 20 mm based on the Standard Specification and Test Methods for Metallic Medical Bone Screws (ASTM F 543-07). Five screws were tested for each failure mode and screw design. The relationship between MIT and compressive force between the plate and bone surrogate was evaluated using pressure-sensitive film. There was a significant difference in mean MIT based on screw pitch (P < 0.0001), whereas POS did not show statistically significant differences among the different screw pitches (P = 0.052). Small screw pitches (1.0 mm and 1.2 mm) had lower MIT and were distinguished from large pitches (1.5 mm, 1.6 mm, and the 1.75 mm) with higher MIT. For POS, only the 1-mm and 1.6-mm pitch screws were found to be different from each other. Linear regression analysis of MIT revealed a moderate correlation to the screw pitch (R(2) = 0.67, P < 0.0001), whereas the analysis of POS suggested no correlation to the screw pitch (R(2) = 0.28, P = 0.006). Pearson correlation analysis indicated no correlation between MIT and POS (P = 0.069, r = -0.37). A linear relationship of increased compression between the plate and bone surrogate was found for increasing screw torque (R(2) = 0.97). These results indicate that the ability of different screw designs to generate high screw insertion torque in a model of osteoporotic cancellous bone is unrelated to their pullout strength. Therefore, extrapolation of results for POS to identify optimal screw design for osteoporotic bone may not be valid. Screw designs that optimize MIT should be sought for fixation in osteoporotic bone.

A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid.

PubMed

Rankin, G; Kuschner, S H; Orlando, C; McKellop, H; Brien, W W; Sherman, R

1991-11-01

The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.

Comparison of effectiveness between cork-screw and peg-screw electrodes for transcranial motor evoked potential monitoring using the finite element method.

PubMed

Tomio, Ryosuke; Akiyama, Takenori; Ohira, Takayuki; Yoshida, Kazunari

2016-01-01

Intraoperative monitoring of motor evoked potentials by transcranial electric stimulation is popular in neurosurgery for monitoring motor function preservation. Some authors have reported that the peg-screw electrodes screwed into the skull can more effectively conduct current to the brain compared to subdermal cork-screw electrodes screwed into the skin. The aim of this study was to investigate the influence of electrode design on transcranial motor evoked potential monitoring. We estimated differences in effectiveness between the cork-screw electrode, peg-screw electrode, and cortical electrode to produce electric fields in the brain. We used the finite element method to visualize electric fields in the brain generated by transcranial electric stimulation using realistic three-dimensional head models developed from T1-weighted images. Surfaces from five layers of the head were separated as accurately as possible. We created the "cork-screws model," "1 peg-screw model," "peg-screws model," and "cortical electrode model". Electric fields in the brain radially diffused from the brain surface at a maximum just below the electrodes in coronal sections. The coronal sections and surface views of the brain showed higher electric field distributions under the peg-screw compared to the cork-screw. An extremely high electric field was observed under cortical electrodes. Our main finding was that the intensity of electric fields in the brain are higher in the peg-screw model than the cork-screw model.

Preventing distal pullout of posterior spine instrumentation in thoracic hyperkyphosis: a biomechanical analysis.

PubMed

Sun, Edward; Alkalay, Ron; Vader, David; Snyder, Brian D

2009-06-01

An in vitro biomechanical study. Compare the mechanical behavior of 5 different constructs used to terminate dual-rod posterior spinal instrumentation in resisting forward flexion moment. Failure of the distal fixation construct can be a significant problem for patients undergoing surgical treatment for thoracic hyperkyphosis. We hypothesize that augmenting distal pedicle screws with infralaminar hooks or sublaminar cables significantly increases the strength and stiffness of these constructs. Thirty-seven thoracolumbar (T12 to L2) calf spines were implanted with 5 configurations of distal constructs: (1) infralaminar hooks, (2) sublaminar cables, (3) pedicle screws, (4) pedicle screws+infralaminar hooks, and (5) pedicle screws+sublaminar cables. Progressive bending moment was applied to each construct until failure. The mode of failure was noted and the construct's stiffness and failure load determined from the load-displacement curves. Bone density and vertebral dimensions were equivalent among the groups (F=0.1 to 0.9, P>0.05). One-way analysis of covariance (adjusted for differences in density and vertebral dimension) demonstrated that all of the screw-constructs (screw, screw+hook, and screw+cable) exhibited significantly higher stiffness and ultimate failure loads compared with either sublaminar hook or cable alone (P<0.05). The screw+hook constructs (109+/-11 Nm/mm) were significantly stiffer than either screws alone (88+/-17 Nm/mm) or screw+cable (98+/-13 Nm/mm) constructs, P<0.05. Screw+cable construct exhibited significantly higher failure load (1336+/-328 N) compared with screw constructs (1102+/-256 N, P<0.05), whereas not statistically different from the screw+hook construct (1220+/-75 N). The cable and hook constructs failed by laminar fracture, screw construct failed in uniaxial shear (pullout), whereas the screws+(hooks or wires) failed by fracture of caudal vertebral body. Posterior dual rod constructs fixed distally using pedicle screws were stiffer and stronger in resisting forward flexion compared with cables or hooks alone. Augmenting these screws with either infralaminar hooks or sublaminar cables provided additional resistance to failure.

The biomechanical effect of artificial and human bone density on stopping and stripping torque during screw insertion.

PubMed

Tsuji, Matthew; Crookshank, Meghan; Olsen, Michael; Schemitsch, Emil H; Zdero, Rad

2013-06-01

Orthopedic surgeons apply torque to metal screws manually by "subjective feel" to obtain adequate fracture fixation, i.e. stopping torque, and attempt to avoid accidental over-tightening that leads to screw-bone interface failure, i.e. stripping torque. Few studies have quantified stripping torque in human bone, and only one older study from 1980 reported stopping/ stripping torque ratio. The present aim was to measure stopping and stripping torque of cortical and cancellous screws in artificial and human bone over a wide range of densities. Sawbone blocks were obtained having densities from 0.08 to 0.80g/cm(3). Sixteen fresh-frozen human femurs of known standardized bone mineral density (sBMD) were also used. Using a torque screwdriver, 3.5-mm diameter cortical screws and 6.5-mm diameter cancellous screws were inserted for adequate tightening as determined subjectively by an orthopedic surgeon, i.e. stopping torque, and then further tightened until failure of the screw-bone interface, i.e. stripping torque. There were weak (R=0.25) to strong (R=0.99) linear correlations of absolute and normalized torque vs. density or sBMD. Maximum stopping torques normalized by screw thread area engaged by the host material were 15.2N/mm (cortical screws) and 13.4N/mm (cancellous screws) in sawbone blocks and 20.9N/mm (cortical screws) and 6.1N/mm (cancellous screws) in human femurs. Maximum stripping torques normalized by screw thread area engaged by the host material were 23.4N/mm (cortical screws) and 16.8N/mm (cancellous screws) in sawbone blocks and 29.3N/mm (cortical screws) and 8.3N/mm (cancellous screws) in human femurs. Combined average stopping/ stripping torque ratios were 80.8% (cortical screws) and 76.8% (cancellous screws) in sawbone blocks, as well as 66.6% (cortical screws) and 84.5% (cancellous screws) in human femurs. Surgeons should be aware of stripping torque limits for human femurs and monitor stopping torque during surgery. This is the first study of the effect of sawbone density or human bone sBMD on stopping and stripping torque. Copyright © 2013 Elsevier Ltd. All rights reserved.

Electrical wiring box with structure for fast device mounting

DOEpatents

Johnston, Earl S.

1991-01-08

An electrical wiring box of molded insulating material is provided with bosses having screw holes for receiving a mounting screw that include two colinear portions of which a first portion proximate the front surface has an internal configuration, such as molded threads, that engage the mounting screw while permitting the mounting screw to be manually inserted therethrough without turning because of flexibility built into the boss structure. A second portion of the screw hole is of greater restriction for securely engaging the screw such as by self tapping. The flexibility of the boss is provided by a first center slot that extends from the screw hole to the boss exterior over a length substantially equal to the first portion of the screw hole. Second and third slots are located respectively on each side of the screw hole and provide projections respectively between the first and second slots and the first and third slots that flex to allow easy screw insertion through the first portion of the screw hole.

Development of structural schemes of parallel structure manipulators using screw calculus

NASA Astrophysics Data System (ADS)

Rashoyan, G. V.; Shalyukhin, K. A.; Gaponenko, EV

2018-03-01

The paper considers the approach to the structural analysis and synthesis of parallel structure robots based on the mathematical apparatus of groups of screws and on a concept of reciprocity of screws. The results are depicted of synthesis of parallel structure robots with different numbers of degrees of freedom, corresponding to the different groups of screws. Power screws are applied with this aim, based on the principle of static-kinematic analogy; the power screws are similar to the orts of axes of not driven kinematic pairs of a corresponding connecting chain. Accordingly, kinematic screws of the outlet chain of a robot are simultaneously determined which are reciprocal to power screws of kinematic sub-chains. Solution of certain synthesis problems is illustrated with practical applications. Closed groups of screws can have eight types. The three-membered groups of screws are of greatest significance, as well as four-membered screw groups [1] and six-membered screw groups. Three-membered screw groups correspond to progressively guiding mechanisms, to spherical mechanisms, and to planar mechanisms. The four-membered group corresponds to the motion of the SCARA robot. The six-membered group includes all possible motions. From the works of A.P. Kotelnikov, F.M. Dimentberg, it is known that closed fifth-order screw groups do not exist. The article presents examples of the mechanisms corresponding to the given groups.

SEM and fractography analysis of screw thread loosening in dental implants.

PubMed

Scarano, A; Quaranta, M; Traini, T; Piattelli, M; Piattelli, A

2007-01-01

Biological and technical failures of implants have already been reported. Mechanical factors are certainly of importance in implant failures, even if their exact nature has not yet been established. The abutment screw fracture or loosening represents a rare, but quite unpleasant failure. The aim of the present research is an analysis and structural examination of screw thread or abutment loosening compared with screw threads or abutment without loosening. The loosening of screw threads was compared to screw thread without loosening of three different implant systems; Branemark (Nobel Biocare, Gothenburg, Sweden), T.B.R. implant systems (Benax, Ancona, Italy) and Restore (Lifecore Biomedical, Chaska, Minnesota, USA). In this study broken screws were excluded. A total of 16 screw thread loosenings were observed (Group I) (4 Branemark, 4 T.B.R and 5 Restore), 10 screw threads without loosening were removed (Group II), and 6 screw threads as received by the manufacturer (unused) (Group III) were used as control (2 Branemark, 2 T.B.R and 2 Restore). The loosened abutment screws were retrieved and analyzed under SEM. Many alterations and deformations were present in concavities and convexities of screw threads in group I. No macroscopic alterations or deformations were observed in groups II and III. A statistical difference of the presence of microcracks were observed between screw threads with an abutment loosening and screw threads without an abutment loosening.

Optimal area of lateral mass mini-screws implanted in plated cervical laminoplasty: a radiography anatomy study.

PubMed

Chen, Hua; Li, Huibo; Deng, Yuxiao; Rong, Xin; Gong, Quan; Li, Tao; Song, Yueming; Liu, Hao

2017-04-01

Lateral mass mini-screws used in plated cervical laminoplasty might penetrate into facet joints. The objective is to observe this complication incidence and to identify the optimal areas for 5- and 7-mm-long mini-screws to implant on lateral mass. 47 patients who underwent plated cervical laminoplasty were included. The optimal area for mini-screws implanting was set according to pre-operative 3D CT reconstruction data. Then, each posterior-lateral mass surface was divided into three regions: 7-mm region, 5-mm region, and dangerous area. The mini-screw implanted region was recorded. Post-operative CT images were used to identify whether the mini-screws penetrated into facet joints. 235 mini-plates and 470 lateral mass mini-screws were used in the study. 117 (24.9%) mini-screws penetrated 88 (37.4%) facet joints. The 5-mm-long mini-screw optimal area occupied the upper 72, 65, 65, 64, and 65 % area of the posterior-lateral mass surface for C3-7, while the 7-mm-long mini-screw optimal area encompassed the upper 54, 39, 40, 33, and 32 %. Only 7-mm-long mini-screws were used to fix the plate to the lateral mass. 4 of 240 mini-screws in 7-mm region, 67 of the 179 mini-screws in 5-mm region, and 46 of the 51 mini-screws in dangerous region penetrated into the facet joint. The differences in the rate of facet joint penetration related to region were statistically significant (P < 0.001). The facet joint destruction by mini-screws was not a rare complication in plated cervical laminoplasty. The optimal areas we proposed may help guide the mini-screw implantation positions.

Finite element analysis of the axial stiffness of a ball screw

NASA Astrophysics Data System (ADS)

Zhou, L.-X.; Li, P.-Y.

2018-06-01

The ball screw was developed for high speed and high precision operation; therefore, increasingly greater demands have been placed on the stiffness of the ball screw. Firstly, ANSYS software was used to compare the axial stiffness of a single-nut and single-arc ball screw and a single-nut and double-arc ball screw when the spiral angle is not considered. On this basis, the model of a single-nut ball screw was established taking into consideration the spiral lead angle, and then the variations in displacement and stiffness when the ball screw pair was subjected to an axial force were determined. The axial contact stiffness of the double-nut ball screw pair, subject to a pre-tightening force, was analyzed, according to the above-mentioned steps. The simulation results demonstrated that under the same working conditions, the stiffness of the double-arc ball screw was larger by between 5∼100 N/um than that of the single-arc ball screw. The spiral lead angle increased the axial stiffness of the ball screw pair, and the axial stiffness of the double-nut ball screw pair subject to a pre-tightening force was larger by between 790∼1360 N/um than that of the axial stiffness of the single-nut ball screw pair.

Ball Screw Actuator Including a Stop with an Integral Guide

NASA Technical Reports Server (NTRS)

Wingett, Paul T. (Inventor); Perek, John (Inventor); Geck, Kellan (Inventor)

2015-01-01

An actuator includes a housing assembly, a ball nut, a ball screw, and a ball screw stop. The ball nut is rotationally mounted in the housing assembly, is adapted to receive an input torque, and is configured, upon receipt thereof, to rotate and supply a drive force. The ball screw is mounted within the housing assembly and extends through the ball nut. The ball screw has a first end and a second end, and is coupled to receive the drive force from the ball nut. The ball screw is configured, upon receipt of the drive force, to selectively translate between a stow position and a deploy position. The ball screw stop is mounted on the ball screw to translate therewith and is configured to at selectively engage the housing assembly while the ball screw is translating, and engage the ball nut when the ball screw is in the deploy position.

Prediction of Deformity Correction by Pedicle Screw Instrumentation in Thoracolumbar Scoliosis Surgery

NASA Astrophysics Data System (ADS)

Kiriyama, Yoshimori; Yamazaki, Nobutoshi; Nagura, Takeo; Matsumoto, Morio; Chiba, Kazuhiro; Toyama, Yoshiaki

In segmental pedicle screw instrumentation, the relationship between the combinations of pedicle screw placements and the degree of deformity correction was investigated with a three-dimensional rigid body and spring model. The virtual thoracolumbar scoliosis (Cobb’s angle of 47 deg.) was corrected using six different combinations of pedicle-screw placements. As a result, better correction in the axial rotation was obtained with the pedicle screws placed at or close to the apical vertebra than with the screws placed close to the end vertebrae, while the correction in the frontal plane was better with the screws close to the end vertebrae than with those close to the apical vertebra. Additionally, two screws placed in the convex side above and below the apical vertebra provided better correction than two screws placed in the concave side. Effective deformity corrections of scoliosis were obtained with the proper combinations of pedicle screw placements.

Percutaneous epiphysiodesis using transphyseal screws for limb-length discrepancies: high variability among growth predictor models.

PubMed

Monier, Bryan C; Aronsson, David D; Sun, Michael

2015-10-01

Percutaneous epiphysiodesis using transphyseal screws (PETS) was developed as a minimally invasive outpatient procedure to address limb-length discrepancy (LLD) that allowed immediate postoperative weight bearing and was potentially reversible by removing the screws. The aims of our study were to report our results using PETS for LLD and evaluate the accuracy of three growth predictor models. Sixteen patients with an average age of 14 years were treated for LLD using PETS. Thirteen patients had screws inserted in a parallel fashion and 3 had crossed screws. We compared the predicted LLD at skeletal maturity using the three growth predictor methods with the actual LLD at skeletal maturity and preoperative LLD with the final LLD at skeletal maturity. The mean LLD at skeletal maturity between the predicted and final measurements was 0.2 cm using the Green-Anderson method, 1.4 cm using the Moseley method, and -0.1 cm using the Paley method. The mean preoperative LLD of 3.1 cm was corrected to 1.7 cm at skeletal maturity (p < 0.001). Six patients complained of pain over the screw heads; however, no patient developed an infection or angular deformity. The three growth predictor methods predicted the final LLD within an average of 1.4 cm, but there was high variability. Although PETS improved the LLD by a mean of 1.4 cm, we believe the results would have been better if PETS was performed at an earlier skeletal age.

Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study.

PubMed

Kosmopoulos, Victor; Luedke, Colten; Nana, Arvind D

2015-01-01

A smaller humerus in some patients makes the use of a large fragment fixation plate difficult. Dual small fragment plate constructs have been suggested as an alternative. This study compares the biomechanical performance of three single and one dual plate construct for mid-diaphyseal humeral fracture fixation. Five humeral shaft finite element models (1 intact and 4 fixation) were loaded in torsion, compression, posterior-anterior (PA) bending, and lateral-medial (LM) bending. A comminuted fracture was simulated by a 1-cm gap. Fracture fixation was modelled by: (A) 4.5-mm 9-hole large fragment plate (wide), (B) 4.5-mm 9-hole large fragment plate (narrow), (C) 3.5-mm 9-hole small fragment plate, and (D) one 3.5-mm 9-hole small fragment plate and one 3.5-mm 7-hole small fragment plate. Model A showed the best outcomes in torsion and PA bending, whereas Model D outperformed the others in compression and LM bending. Stress concentrations were located near and around the unused screw holes for each of the single plate models and at the neck of the screws just below the plates for all the models studied. Other than in PA bending, Model D showed the best overall screw-to-screw load sharing characteristics. The results support using a dual small fragment locking plate construct as an alternative in cases where crutch weight-bearing (compression) tolerance may be important and where anatomy limits the size of the humerus bone segment available for large fragment plate fixation.

Are computer numerical control (CNC)-manufactured patient-specific metal templates available for posterior thoracic pedicle screw insertion? Feasibility and accuracy evaluation.

PubMed

Kong, Xiangxue; Tang, Lei; Ye, Qiang; Huang, Wenhua; Li, Jianyi

2017-11-01

Accurate and safe posterior thoracic pedicle insertion (PTPI) remains a challenge. Patient-specific drill templates (PDTs) created by rapid prototyping (RP) can assist in posterior thoracic pedicle insertion, but pose biocompatibility risks. The aims of this study were to develop alternative PDTs with computer numerical control (CNC) and assess their feasibility and accuracy in assisting PTPI. Preoperative CT images of 31 cadaveric thoracic vertebras were obtained and then the optimal pedicle screw trajectories were planned. The PDTs with optimal screw trajectories were randomly assigned to be designed and manufactured by CNC or RP in each vertebra. With the guide of the CNC- or RP-manufactured PDTs, the appropriate screws were inserted into the pedicles. Postoperative CT scans were performed to analyze any deviations at entry point and midpoint of the pedicles. The CNC group was found to be significant manufacture-time-shortening, and cost-decreasing, when compared with the RP group (P < 0.01). The PDTs fitted the vertebral laminates well while all screws were being inserted into the pedicles. There were no significant differences in absolute deviations at entry point and midpoint of the pedicle on either axial or sagittal planes (P > 0.05). The screw positions were grade 0 in 90.3% and grade 1 in 9.7% of the cases in the CNC group and grade 0 in 93.5% and grade 1 in 6.5% of the cases in the RP group (P = 0.641). CNC-manufactured PDTs are viable for assisting in PTPI with good feasibility and accuracy.

Screw Placement and Osteoplasty Under Computed Tomographic-Fluoroscopic Guidance in a Case of Advanced Metastatic Destruction of the Iliosacral Joint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Trumm, Christoph Gregor, E-mail: christoph.trumm@med.lmu.de; Rubenbauer, Bianca; Piltz, Stefan

We present a case of combined surgical screw placement and osteoplasty guided by computed tomography-fluoroscopy (CTF) in a 68-year-old man with unilateral osteolytic destruction and a pathological fracture of the iliosacral joint due to a metastasis from renal cell carcinoma. The patient experienced intractable lower back pain that was refractory to analgesia. After transarterial particle and coil embolization of the tumor-feeding vessels in the angiography unit, the procedure was performed under general anesthesia by an interdisciplinary team of interventional radiologists and trauma surgeons. Under intermittent single-shot CTF, two K wires were inserted into the left iliosacral joint from a lateralmore » transiliac approach at the S1 level followed by two self-tapping surgical screws. Continuous CTF was used for monitoring of the subsequent polymethylmethacrylate injection through two vertebroplasty cannulas for further stabilization of the screw threads within the osteolytic sacral ala. Both the screw placement and cement injection were successful, with no complications occurring during or after the procedure. With additional nonsteroidal anti-inflammatory and opioid medication, the patient reported a marked decrease in his lower back pain and was able to move independently again at the 3-month follow-up assessment. In our patient with intolerable back pain due to tumor destruction and consequent pathological fracture of the iliosacral joint, CTF-guided iliosacral screw placement combined with osteoplasty was successful with respect to joint stabilization and a reduction in the need for analgesic therapy.« less

Rates of Upper Facet Joint Violation in Minimally Invasive Percutaneous and Open Instrumentation: A Comparative Cohort Study of Different Insertion Techniques.

PubMed

Archavlis, Eleftherios; Amr, Nimer; Kantelhardt, Sven Rainer; Giese, Alf

2018-01-01

 Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint.  We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation.  A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016. All operations were performed by the same surgeon; the patients were divided into three groups according to the method of instrumentation. Group 1 involved the robot-assisted instrumentation in 58 patients, group 2 consisted of 64 patients treated with a percutaneous transpedicular instrumentation using fluoroscopic guidance, and 72 patients in group 3 received an open midline approach for pedicle screw insertion.  Superior segment facet joint violation occurred in 2 patients in the robot-assisted group 1 (7%), in 22 of the percutaneous fluoroscopy-guided group 2 (34%), and in 6 cases of the open group (8%). The incidence of facet joint violation was present in 5% (3) of the screws in group 1, 22% (28) of the screws in group 2, and 3% (4) of the screws in group 3.  Meticulous surgical planning of the appropriate entry site (Weinstein's method), trajectory planning, and proper robot-assisted instrumentation of pedicle screws reduced the risk of superior segment facet joint violation. Georg Thieme Verlag KG Stuttgart · New York.

Is Polymethyl Methacrylate a Viable Option for Salvaging Lateral Mass Screw Failure in the Subaxial Cervical Spine?

PubMed Central

Gallizzi, Michael A.; Kuhns, Craig A.; Jenkins, Tyler J.; Pfeiffer, Ferris M.

2014-01-01

Study Design Biomechanical analysis of lateral mass screw pullout strength. Objective We compare the pullout strength of our bone cement–revised lateral mass screw with the standard lateral mass screw. Methods In cadaveric cervical spines, we simulated lateral mass screw “cutouts” unilaterally from C3 to C7. We salvaged fixation in the cutout side with polymethyl methacrylate (PMMA) or Cortoss cement (Orthovita, Malvern, Pennsylvania, United States), allowed the cement to harden, and then drilled and placed lateral mass screws back into the cement-augmented lateral masses. On the contralateral side, we placed standard lateral mass screws into the native, or normal lateral, masses and then compared pullout strength of the cement-augmented side to the standard lateral mass screw. For pullout testing, each augmentation group was fixed to a servohydraulic load frame and a specially designed pullout fixture was attached to each lateral mass screw head. Results Quick-mix PMMA-salvaged lateral mass screws required greater force to fail when compared with native lateral mass screws. Cortoss cement and PMMA standard-mix cement-augmented screws demonstrated less strength of fixation when compared with control-side lateral mass screws. Attempts at a second round of cement salvage of the same lateral masses led to more variations in load to failure, but quick-mix PMMA again demonstrated greater load to failure when compared with the nonaugmented control lateral mass screws. Conclusion Quick-mix PMMA cement revision equips the spinal surgeon with a much needed salvage option for a failed lateral mass screw in the subaxial cervical spine. PMID:25649421

A new method to precisely control the depth of percutaneous screws into the pedicle by counting the rotation number of the screw with low radiation exposure: technical note.

PubMed

Li, Xu; Zhang, Feng; Zhang, Wenzhi; Shang, Xifu; Han, Jintao; Liu, Pengfei

2017-03-01

Technique note. To report a new method for precisely controlling the depth of percutaneous pedicle screws (PPS)-without radiation exposure to surgeons and less fluoroscopy exposure to patients than with conventional methods. PPS is widely used in minimal invasive spine surgery; the advantages include reduced muscle damage, pain, and hospital stays. However, placement of PPS demands repeated checking with fluoroscopy. Thus, radiation exposure is considerable for both surgeons and patients. The PPS depth was determined by counting rotations of the screws. The distance between screw threads can be measured for particular screws; thus, full rotations of the PPS results in the screw advancing in the pedicle the distance between screw threads. To fully insert screws into the pedicle, the number of full rotations is equal to the number of threads in the PPS. We applied this technique in 58 patients with thoracolumbar fracture. The position and depth of the screws was checked during the operation with the C-arm and after operation by anteroposterior X-ray film or computed tomography. No additional procedures were required to correct the screws; we observed no neurological deficits or malpositioning of the screws. In the screw placement procedure, the radiation exposure for surgeons is zero, and the patient is well protected from extensive radiation exposure. This method of counting rotation of screws is a safe way to precisely determine the depth of PPS in the placement procedure. IV.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation.

PubMed

Dumpa, Srikanth Reddy; Shetty, Ajoy Prasad; Aiyer, Siddharth N; Kanna, Rishi Mugesh; Rajasekaran, S

2018-04-01

Retrospective observational study. To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. PCA changed significantly from 57.6°±13.9° to 19°±8.4° ( p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK ( p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation

PubMed Central

Dumpa, Srikanth Reddy; Aiyer, Siddharth N.; Kanna, Rishi Mugesh; Rajasekaran, S

2018-01-01

Study Design Retrospective observational study. Purpose To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. Overview of Literature LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. Methods A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. Results PCA changed significantly from 57.6°±13.9° to 19°±8.4° (p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK (p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). Conclusions LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis. PMID:29713412

Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note.

PubMed

Antar, Veysel; Turk, Okan

2018-03-01

Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

The general theory of blade screws including propellers, fans, helicopter screws, helicoidal pumps, turbo-motors, and different kinds of helicoidal blades

NASA Technical Reports Server (NTRS)

De Bothezat, George

1920-01-01

Report presents a theory which gives a complete picture and an exact quantitative analysis of the whole phenomenon of the working of blade screws, but also unites in a continuous whole the entire scale of states of work conceivable for a blade screw. Chapter 1 is devoted to the establishment of the system of fundamental equations relating to the blade screw. Chapter 2 contains the general discussion of the 16 states of work which may establish themselves for a blade screw. The existence of the vortex ring state and the whirling phenomenon are established. All the fundamental functions which enter the blade-screw theory are submitted to a general analytical discussion. The general outline of the curve of the specific function is examined. Two limited cases of the work of the screw, the screw with a zero constructive pitch and the screw with an infinite constructive pitch, are pointed out. Chapter 3 is devoted to the study of the propulsive screw or propeller. (author)

Research and application of absorbable screw in orthopedics: a clinical review comparing PDLLA screw with metal screw in patients with simple medial malleolus fracture.

PubMed

Tang, Jin; Hu, Jin-feng; Guo, Wei-chun; Yu, Ling; Zhao, Sheng-hao

2013-01-01

To observe the therapeutic effect of absorbable screw in medial malleolus fracture and discuss its clinical application in orthopedics. A total of 129 patients with simple medial malleolus fracture were studied. Among them, 64 patients were treated with poly-D, L-lactic acid (PDLLA) absorbable screws, while the others were treated with metal screws. All the patients were followed up for 12-20 months (averaged 18.4 months) and the therapeutic effect was evaluated according to the American Orthopaedic Foot and Ankle Society clinical rating systems. In absorbable screw group, we obtained excellent and good results in 62 cases (96.88%); in steel screw group, 61 cases (93.85%) achieved excellent and good results. There was no significant difference between the two groups. In the treatment of malleolus fracture, absorbable screw can achieve the same result compared with metal screw fixation. Absorbable screw is preferred due to its advantages of safety, cleanliness and avoiding the removal procedure associated with metallic implants.

Preload evaluation of different screws in external hexagon joint.

PubMed

Assunção, Wirley Gonçalves; Delben, Juliana Aparecida; Tabata, Lucas Fernando; Barão, Valentim Adelino Ricardo; Gomes, Erica Alves; Garcia, Idelmo Rangel

2012-02-01

This study compared the maintenance of tightening torque in different retention screw types of implant-supported crowns. Twelve metallic crowns in UCLA abutments cast with cobalt-chromium alloy were attached to external hexagon osseointegrated implants with different retention screws: group A: titanium alloy retention screw; group B: gold alloy retention screw with gold coating; group C: titanium alloy retention screw with diamond-like carbon film coating; and group D: titanium alloy retention screw with aluminum titanium nitride coating. Three detorque measurements were obtained after torque insertion in each replica. Data were evaluated by analysis of variance (ANOVA), Tukey's test (P < 0.05), and t test (P < 0.05). Detorque value reduced in all groups (P < 0.05). Group A retained the highest percentage of torque in comparison with the other groups (P < 0.05). Groups B and D retained the lowest percentage of torque without statistically significant difference between them (P > 0.05). All screw types exhibited reduction in the detorque value. The titanium screw maintained the highest percentage of torque whereas the gold-coated screw and the titanium screw with aluminum titanium nitride coating retained the lowest percentage.

Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).

PubMed

Herthel, T D; Rick, M C; Judy, C E; Cohen, N D; Herthel, D J

2016-09-01

Outcomes associated with arthrodesis of the proximal interphalangeal (PIP) joint in Quarter Horses used for Western performance activities are well documented but little is known regarding outcomes for other types of horses. To identify factors associated with outcomes, including breed and activity, after arthrodesis of the PIP joint in Warmbloods, Thoroughbreds and Quarter Horses. Retrospective case series. Surgical case records of 82 Quarter Horses principally engaged in Western performance and Thoroughbred or Warmblood breeds principally engaged in showing, showjumping and dressage, with arthrodesis of the PIP joint were reviewed. Arthrodesis was performed with either 3 transarticular cortex bone screws placed in lag fashion, a dynamic compression plate (DCP) with 2 transarticular cortex bone screws placed in lag fashion, or a locking compression plate (LCP) with 2 transarticular cortex bone screws placed in lag fashion. Demographic data, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow-up was obtained for all 82 horses. Osteoarthritis of the PIP joint was the most common presenting condition requiring arthrodesis, which was performed with either the 3 screw technique (n = 41), DCP fixation (n = 22), or LCP fixation (n = 19). Post operatively, 23/31 (74%) Warmbloods/Thoroughbreds and 44/51 (87%) Quarter Horses achieved successful outcomes. Thirteen of 23 (57%) Warmbloods/Thoroughbreds and 24 of 38 (63%) Quarter Horses, used for athletic performance, returned to successful competition. Within this subgroup of horses engaged in high-level activity, regardless of breed type, horses undergoing hindlimb arthrodesis were significantly more likely to return to successful competition (73%; 33/45) than those with forelimb arthrodesis (25%; 4/16, P = 0.002). Arthrodesis of the PIP joint in Warmbloods/Thoroughbreds and Quarter Horses results in a favourable outcome for return to their intended use and athletic competition. © 2015 EVJ Ltd.

Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.

PubMed

Nousiainen, Markku T; Omoto, Daniel M; Zingg, Patrick O; Weil, Yoram A; Mardam-Bey, Sami W; Eward, William C

2013-02-01

: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.

Preloads generated with repeated tightening in three types of screws used in dental implant assemblies.

PubMed

Byrne, Declan; Jacobs, Stuart; O'Connell, Brian; Houston, Frank; Claffey, Noel

2006-01-01

Abutment screw loosening, especially in the case of cemented single tooth restorations, is a cause of implant restoration failure. This study compared three screws (titanium alloy, gold alloy, and gold-coated) with similar geometry by recording the preload induced when torques of 10, 20, and 35 Ncm were used for fixation. Two abutment types were used-prefabricated preparable abutments and cast-on abutments. A custom-designed rig was used to measure preload in the abutment-screw-implant assembly with a strain gauge. Ten screws of each type were sequentially tightened to 10, 20, and 35 Ncm on ten of the two abutment types. The same screws were then loosened and re-tightened. This procedure was repeated. Thus, each screw was tightened on three occasions to the three insertion torques. A linear regression model was used to analyze the effects on preload values of screw type and abutment type for each of the three insertion torques. The results indicated that the gold-coated screw generated the highest preloads for all insertion torques and for each tightening episode. Further analysis focused on the effects of screw type and abutment type for each episode of tightening and for each fixation torque. The gold-coated screw, fixed to the prefabricated abutment, displayed higher preloads for the first tightening at 10, 20, and 35 Ncm. Conversely, the same screw fixed to the cast-on abutment showed higher values for the second and third tightening for all fixation torques. All screws showed decay in preload with the number of times tightened. Given the higher preloads generated using the gold-coated screw with both abutment types, it is more likely that this type of screw will maintain a secure joint when tightened for the second and third time. All screw types displayed some decay in preload with repeated tightening, irrespective of abutment type and insertion torque. The gold-coated screw showed markedly higher preloads for all insertion torques and for all instances of tightening when compared with the uncoated screws.

Use of computed tomography to define a sacral safe corridor for placement of 2.7 mm cortical screws in feline sacroiliac luxation.

PubMed

Philp, Helen; Durand, Alexane; De Vicente, Felipe

2018-06-01

Objectives This study aimed to define a safe corridor for 2.7 mm cortical sacroiliac screw insertion in the dorsal plane (craniocaudal direction) using radiography and CT, and in the transverse plane (dorsoventral direction) using CT in feline cadavers. A further aim was to compare the values obtained by CT with those previously reported by radiography in the transverse plane. Methods Thirteen pelvises were retrieved from feline cadavers and dissected to expose one of the articular surfaces of the sacrum. A 2.7 mm screw was placed in the sacrum to a depth of approximately 1 cm in each exposed articular surface. Dorsoventral radiography and CT scanning of each specimen were performed. Multiplanar reconstructions were performed to allow CT evaluation in both the dorsal and transverse planes. Calculations were made to find the maximum, minimum and optimum angles for screw placement in craniocaudal (radiography and CT) and dorsoventral (CT) directions when using a 2.7 mm cortical screw. Results Radiographic measurement showed a mean optimum craniocaudal angle of 106° (range 97-112°). The mean minimum angle was 95° (range 87-107°), whereas the mean maximum angle was 117° (108-124°). Measurement of the dorsal CT scan images showed a mean optimum craniocaudal angle of 101° (range 94-110°). The mean minimum angle was 90° (range 83-99°), whereas the mean maximum angle was 113° (104-125°). The transverse CT scan images showed a mean dorsoventral minimum angle of 103° (range 95-113°), mean maximum angle of 115° (104-125°) and mean optimum dorsoventral angle of 111° (102-119°). Conclusions and relevance An optimum craniocaudal angle of 101° is recommended for 2.7 mm cortical screw placement in the feline sacral body, with a safety margin between 99° and 104°. No single angle can be recommended in the dorsoventral direction and therefore preoperative measuring on individual cats using CT images is recommended to establish the ideal individual angle in the transverse plane.

Standard Waste Box Lid Screw Removal Option Testing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anast, Kurt Roy

This report provides results from test work conducted to resolve the removal of screws securing the standard waste box (SWB) lids that hold the remediated nitrate salt (RNS) drums. The test work evaluated equipment and process alternatives for removing the 42 screws that hold the SWB lid in place. The screws were secured with a red Loctite thread locker that makes removal very difficult because the rivets that the screw threads into would slip before the screw could be freed from the rivet, making it impossible to remove the screw and therefore the SWB lid.

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study.

PubMed

Huang, Xiaowei; Zhi, Zhongzheng; Yu, Baoqing; Chen, Fancheng

2015-11-25

The purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture. A three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60% to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures. The mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P < 0.001) smaller than that of the screw fixation system. The maximal value of displacement (sum) in the plate-screw fixation system was 2.46 mm, which was lower than that in the screw fixation system (3.91 mm). The peak stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001). This study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.

A biomechanical study comparing a raft of 3.5 mm cortical screws with 6.5 mm cancellous screws in depressed tibial plateau fractures.

PubMed

Patil, Sunit; Mahon, Andrew; Green, Sarah; McMurtry, Ian; Port, Andrew

2006-06-01

There has been a recent trend towards using a raft of small diameter 3.5mm cortical screws for supporting depressed tibial plateau fractures (Schatzker type III). Our aim was to compare the biomechanical properties of a raft of 3.5 mm cortical screws with that of 6.5 mm cancellous screws in a synthetic bone model. Ten rigid polyurethane foam (sawbone) blocks, with a density simulating osteoporotic bone and ten blocks with a density simulating normal density bone were obtained. A Schatzker type III fracture was created in each block. The fracture fragments were then elevated and supported using two 6.5 mm cancellous screws in ten blocks and four 3.5 mm cortical screws in the remaining. The fractures were loaded using a Lloyd testing machine. The mean force needed to produce a depression of 5 mm was 700.8 N with the four-screw construct and 512.4 N with the two-screw construct in the osteoporotic model. This difference was highly statistically significant (p = 0.009). The mean force required to produce the same depression was 1878.2 N with the two-screw construct and 1938.2 N with the four-screw construct in the non-osteoporotic model. Though the difference was not statistically significant (p = 0.42), an increased fragmentation of the synthetic bone fragments was noticed with the two-screw construct but not with the four-screw construct. A raft of four 3.5 mm cortical screws is biomechanically stronger than two 6.5 mm cancellous screws in resisting axial compression in osteoporotic bone.

Fracture Gap Reduction With Variable-Pitch Headless Screws.

PubMed

Roebke, Austin J; Roebke, Logan J; Goyal, Kanu S

2018-04-01

Fully threaded, variable-pitch, headless screws are used in many settings in surgery and have been extensively studied in this context, especially in regard to scaphoid fractures. However, it is not well understood how screw parameters such as diameter, length, and pitch variation, as well as technique parameters such as depth of drilling, affect gap closure. Acutrak 2 fully threaded variable-pitch headless screws of various diameters (Standard, Mini, and Micro) and lengths (16-28 mm) were inserted into polyurethane blocks of "normal" and "osteoporotic" bone model densities using a custom jig. Three drilling techniques (drill only through first block, 4 mm into second block, or completely through both blocks) were used. During screw insertion, fluoroscopic images were taken and later analyzed to measure gap reduction. The effect of backing the screw out after compression was evaluated. Drilling at least 4 mm past the fracture site reduces distal fragment push-off compared with drilling only through the proximal fragment. There were no significant differences in gap closure in the normal versus the osteoporotic model. The Micro screw had a smaller gap closure than both the Standard and the Mini screws. After block contact and compression with 2 subsequent full forward turns, backing the screw out by only 1 full turn resulted in gapping between the blocks. Intuitively, fully threaded headless variable-pitch screws can obtain compression between bone fragments only if the initial gap is less than the gap closed. Gap closure may be affected by drilling technique, screw size, and screw length. Fragment compression may be immediately lost if the screw is reversed. We describe characteristics of variable-pitch headless screws that may assist the surgeon in screw choice and method of use. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Misfit of implant prostheses and its impact on clinical outcomes. Definition, assessment and a systematic review of the literature.

PubMed

Katsoulis, Joannis; Takeichi, Takuro; Sol Gaviria, Ana; Peter, Lukas; Katsoulis, Konstantinos

Compromised fit between the contact surfaces of screw-retained implant-supported fixed dentures (IFDs) is thought to create uncontrolled strains in the prosthetic components and peri-implant tissues, thus evoking biological and technical complications such as bone loss, screw loosening, component fractures and, at worst, loss of implants or prostheses. The aim of this systematic review was to evaluate the impact of marginal misfit on the clinical outcomes of IFDs, and to elucidate definition and assessment methods for passive fit. A systematic review of the literature was conducted with a PICO question: "For partially or complete edentulous subjects with screw-retained IFDs, does the marginal misfit at the implant-prosthesis interfaces have an impact on the clinical outcomes?". A literature search was performed electronically in PubMed (MEDLINE) with the help of Boolean operators to combine key words, and by hand search in relevant journals. English written in vivo studies published before August 31, 2016 that reported on both clinical outcome and related implant prosthesis misfit (gap, strains, torque) were selected using predetermined inclusion criteria. The initial search yielded 2626 records. After screening and a subsequent filtering process, five human and five animal studies were included in the descriptive analysis. The selected studies used different methods to assess misfit (linear distortion, vertical gap, strains, screw torque). While two human studies evaluated the biological response and technical complications prospectively over 6 and 12 months, the animal studies had an observation period < 12 weeks. Four human studies analysed retrospectively the 3 to 32 years' outcomes. Screw-related complications were observed, but biological sequelae could not be confirmed. Although the animal studies had different designs, bone adaptation and implant displacement was found in histological analyses. Due to the small number of studies and the heterogenic designs and misfit assessment methods, no meta-analysis of the data could be performed. The current literature provides insufficient evidence as to the effect of misfit at the prosthesis-implant interface on clinical outcomes of screw-retained implant-supported fixed dentures. Marginal gaps and static strains due to screw tightening were not found to have negative effects on initial osseointegration or peri-implant bone stability over time. Based on two clinical studies, the risk for technical screw-related complications was slightly higher. While the degree of tolerable misfit remains a matter of debate, the present data do not imply that clinicians neglect good fit, but aim to achieve the least misfit possible. Conflict of interest statement: The authors declare no conflict of interest. The review was conducted as part of the 2016 Foundation of Oral Rehabilitation Consensus Conference on "Prosthetic Protocols in Implant-based Oral Rehabilitation".

Comparison of computer-assisted surgery with conventional technique for the treatment of axial distal phalanx fractures in horses: an in vitro study.

PubMed

Andritzky, Juliane; Rossol, Melanie; Lischer, Christoph; Auer, Joerg A

2005-01-01

To compare the precision obtained with computer-assisted screw insertion for treatment of mid-sagittal articular fractures of the distal phalanx (P3) with results achieved with a conventional technique. In vitro experimental study. Thirty-two cadaveric equine limbs. Four groups of 8 limbs were studied. Either 1 or 2 screws were inserted perpendicular to an imaginary axial fracture of P3 using computer-assisted surgery (CAS) or conventional technique. Screw insertion time, predetermined screw length, inserted screw length, fit of the screw, and errors in placement were recorded. CAS technique took 15-20 minutes longer but resulted in greater precision of screw length and placement compared with the conventional technique. Improved precision in screw insertion with CAS makes insertion of 2 screws possible for repair of mid-sagittal P3 fractures. CAS although expensive improves precision in screw insertion into P3 and consequently should yield improved clinical outcome.

[Osteosynthesis of Weber B ankle fractures using the one-third tubular plate and refixation of the syndesmosis].

PubMed

Spering, C; Lesche, V; Dresing, K

2015-08-01

Anatomical reconstruction and recovery to complete range of function of the upper ankle joint. Therefore, the most stable but least invasive osteosynthesis is required to enable the patient early functional mobilization. Supination and pronation fracture with luxation mechanism of the upper ankle joint with or without rupture of the syndesmosis. Open fracture of the distal fibula including displaced and instable fractures. Severe peripheral arterial occlusive disease; contaminated open fractures (≥ 2nd degree); pediatric fractures with open epiphyseal plate. Supine position with ipsilateral slightly elevated hip and knee. Incision of about 8 cm length along the dorsal edge of the distal fibula. When reaching the lateral malleolus, a slight ventral angulation is necessary. Open reduction through this posterolateral approach. Secure the reposition using an interfragmentary lag screw and anatomically adjusted third tubular plate. Followed by a revision of the syndesmosis and transfixation using a tricortical position screw. Mobilization on day 1 after surgery with reduced weight-bearing when position screw is not applied; when position screw is implanted with ground contact for 6 weeks. Removal of position screw under local anesthesia after 6 weeks and pain-controlled full weight-bearing. Removal of metal after 1.5 years. Open reduction using the third tubular plate and an interfragmentary lag screw through a dorsolateral approach used in 90 % of all Weber B fractures in our clinic. Additional revision of a ruptured syndesmosis performed in 70 % and transfixation through a position screw in 40 %. Persisting instability in the upper ankle joint significantly reduced after surgical treatment compared to a conservative approach. Revisions necessary in 3.7 % of patients and pseudarthrosis diagnosed in 0.9 %. It has been shown that the preoperative x-ray and clinical examination is limited in detecting a ruptured syndesmosis.

Placement of iliosacral screws using 3D image-guided (O-Arm) technology and Stealth Navigation: comparison with traditional fluoroscopy.

PubMed

Theologis, A A; Burch, S; Pekmezci, M

2016-05-01

We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy. Iliosacral screws were introduced percutaneously into the first sacral body (S1) of ten human cadavers, four men and six women. The mean age was 77 years (58 to 85). Screws were introduced using a standard technique into the left side of S1 using C-Arm fluoroscopy and then into the right side using O-Arm/Stealth Navigation. The radiation was measured on the surgeon by dosimeters placed under a lead thyroid shield and apron, on a finger, a hat and on the cadavers. There were no neuroforaminal breaches in either group. The set-up time for the O-Arm was significantly longer than for the C-Arm, while total time for placement of the screws was significantly shorter for the O-Arm than for the C-Arm (p = 0.001). The mean absorbed radiation dose during fluoroscopy was 1063 mRad (432.5 mRad to 4150 mRad). No radiation was detected on the surgeon during fluoroscopy, or when he left the room during the use of the O-Arm. The mean radiation detected on the cadavers was significantly higher in the O-Arm group (2710 mRem standard deviation (sd) 1922) than during fluoroscopy (11.9 mRem sd 14.8) (p < 0.01). O-Arm/Stealth Navigation allows for faster percutaneous placement of iliosacral screws in a radiation-free environment for surgeons, albeit with the same accuracy and significantly more radiation exposure to cadavers, when compared with standard fluoroscopy. Placement of iliosacral screws with O-Arm/Stealth Navigation can be performed safely and effectively. Cite this article: Bone Joint J 2016;98-B:696-702. ©2016 The British Editorial Society of Bone & Joint Surgery.

Comparison of computer assisted surgery with conventional technique for treatment of abaxial distal phalanx fractures in horses: an in vitro study.

PubMed

Rossol, Melanie; Gygax, Diego; Andritzky-Waas, Juliane; Zheng, Guoyan; Lischer, Christoph J; Zhang, Xuan; Auer, Joerg A

2008-01-01

To (1) evaluate and compare computer-assisted surgery (CAS) with conventional screw insertion (conventional osteosynthesis [COS]) for treatment of equine abaxial distal phalanx fractures; (2) compare planned screw position with actual postoperative position; and (3) determine preferred screw insertion direction. Experimental study. Cadaveric equine limbs (n=32). In 8 specimens each, a 4.5 mm cortex bone screw was inserted in lag fashion in dorsopalmar (plantar) direction using CAS or COS. In 2 other groups of 8, the screws were inserted in opposite direction. Precision of CAS was determined by comparison of planned and actual screw position. Preferred screw direction was also assessed for CAS and COS. In 4 of 6 direct comparisons, screw positioning was significantly better with CAS. Results of precision analysis for screw position were similar to studies published in human medicine. None of evaluated criteria identified a preferred direction for screw insertion. For abaxial fractures of the distal phalanx, superior precision in screw position is achieved with CAS technique compared with COS technique. Abaxial fractures of the distal phalanx lend themselves to computer-assisted implantation of 1 screw in a dorsopalmar (plantar) direction. Because of the complex anatomic relationships, and our results, we discourage use of COS technique for repair of this fracture type.

Development of the Gliding Hole of the Dynamics Compression Plate

NASA Astrophysics Data System (ADS)

Salim, U. A.; Suyitno; Magetsari, R.; Mahardika, M.

2017-02-01

The gliding hole of the dynamics compression plate is designed to facilitate relative movement of pedicle screw during surgery application. The gliding hole shape is then geometrically complex. The gliding hole manufactured using machining processes used to employ ball-nose cutting tool. Then, production cost is expensive due to long production time. This study proposed to increase productivity of DCP products by introducing forming process (cold forming). The forming process used to involve any press tool devices. In the closed die forming press tool is designed with little allowance, then work-pieces is trapped in the mould after forming. Therefore, it is very important to determine hole geometry and dimensions of raw material in order to success on forming process. This study optimized the hole sizes with both geometry analytics and experiments. The success of the forming process was performed by increasing the holes size on the raw materials. The holes size need to be prepared is diameter of 5.5 mm with a length of 11.4 mm for the plate thickness 3 mm and diameter of 6 mm with a length of 12.5 mm for the plate thickness 4 mm.

Using three-dimensional rapid prototyping in the design and development of orthopaedic screws in standardised pull-out tests.

PubMed

Leslie, Laura Jane; Connolly, Ashley; Swadener, John G; Junaid, Sarah; Theivendran, Kanthan; Deshmukh, Subodh C

2018-06-01

The majority of orthopaedic screws are designed, tested and manufactured by existing orthopaedics companies and are predominantly developed with healthy bone in mind. The timescales and costs involved in the development of a new screw design, for example, for osteoporotic bone, are high. In this study, standard wood screws were used to analyse the concept of using three-dimensional printing, or rapid prototyping, as a viable stage of development in the design of a new bone screw. Six wood screws were reverse engineered and printed in polymeric material using stereolithography. Three of the designs were also printed in Ti6Al4V using direct metal laser sintering; however, these were not of sufficient quality to test further. Both the original metal screws (metal) and polymeric rapid prototyping screws were then tested using standard pull-out tests from low-density polyurethane blocks (Sawbones). Results showed the highest pull-out strengths for screws with the longest thread length and the smallest inner diameter. Of the six screw designs tested, five showed no more than a 17% variance between the metal and rapid prototyping results. A similar pattern of results was shown between the screw designs for both the metal and rapid prototyping screws in five of the six cases. While not producing fully comparable pull-out results to orthopaedic screws, the results from this study do provide evidence of the potential usefulness and cost-effectiveness of rapid prototyping in the early stages of design and testing of orthopaedic screws.

Thoracic, Lumbar, and Sacral Pedicle Screw Placement Using Stryker-Ziehm Virtual Screw Technology and Navigated Stryker Cordless Driver 3: Technical Note.

PubMed

Satarasinghe, Praveen; Hamilton, Kojo D; Tarver, Michael J; Buchanan, Robert J; Koltz, Michael T

2018-04-17

Utilization of pedicle screws (PS) for spine stabilization is common in spinal surgery. With reliance on visual inspection of anatomical landmarks prior to screw placement, the free-hand technique requires a high level of surgeon skill and precision. Three-dimensional (3D), computer-assisted virtual neuronavigation improves the precision of PS placement and minimization steps. Twenty-three patients with degenerative, traumatic, or neoplastic pathologies received treatment via a novel three-step PS technique that utilizes a navigated power driver in combination with virtual screw technology. (1) Following visualization of neuroanatomy using intraoperative CT, a navigated 3-mm match stick drill bit was inserted at an anatomical entry point with a screen projection showing a virtual screw. (2) A Navigated Stryker Cordless Driver with an appropriate tap was used to access the vertebral body through a pedicle with a screen projection again showing a virtual screw. (3) A Navigated Stryker Cordless Driver with an actual screw was used with a screen projection showing the same virtual screw. One hundred and forty-four consecutive screws were inserted using this three-step, navigated driver, virtual screw technique. Only 1 screw needed intraoperative revision after insertion using the three-step, navigated driver, virtual PS technique. This amounts to a 0.69% revision rate. One hundred percent of patients had intraoperative CT reconstructed images taken to confirm hardware placement. Pedicle screw placement utilizing the Stryker-Ziehm neuronavigation virtual screw technology with a three step, navigated power drill technique is safe and effective.

Biomechanical evaluation of a second generation headless compression screw for ankle arthrodesis in a cadaver model.

PubMed

Somberg, Andrew Max; Whiteside, William K; Nilssen, Erik; Murawski, Daniel; Liu, Wei

2016-03-01

Many types of screws, plates, and strut grafts have been utilized for ankle arthrodesis. Biomechanical testing has shown that these constructs can have variable stiffness. More recently, headless compression screws have emerged as an evolving method of achieving compression in various applications but there is limited literature regarding ankle arthrodesis. The aim of this study was to determine the biomechanical stability provided by a second generation fully threaded headless compression screw compared to a standard headed, partially threaded cancellous screw in a cadaveric ankle arthrodesis model. Twenty fresh frozen human cadaver specimens were subjected to simulated ankle arthrodesis with either three standard cancellous-bone screws (InFix 7.3mm) or with three headless compression screws (Acumed Acutrak 2 7.5mm). The specimens were subjected to cyclic loading and unloading at a rate of 1Hz, compression of 525 Newtons (N) and distraction of 20N for a total of 500 cycles using an electromechanical load frame (Instron). The amount of maximum distraction was recorded as well as the amount of motion that occurred through 1, 10, 50, 100, and 500 cycles. No significant difference (p=0.412) was seen in the amount of distraction that occurred across the fusion site for either screw. The average maximum distraction after 500 cycles was 201.9μm for the Acutrak 2 screw and 235.4μm for the InFix screw. No difference was seen throughout each cycle over time for the Acutrak 2 screw (p-value=0.988) or the InFix screw (p-value=0.991). Both the traditional InFix type screw and the second generation Acumed Acutrak headless compression screws provide adequate fixation during ankle arthrodesis under submaximal loads. There is no demonstrable difference between traditional cannulated partially threaded screws and headless compression screws studied in this model. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Continuous powder feeding for pharmaceutical solid dosage form manufacture: a short review.

PubMed

Blackshields, Caroline A; Crean, Abina M

2018-07-01

There has been a noticeable shift from pharmaceutical batch processing towards a more continuous mode of manufacture for solid oral dosage forms. Continuous solid oral dose processes would not be possible in the absence of a highly accurate feeding system. The performance of feeders defines the content of formulations and is therefore a critical operation in continuous manufacturing of solid dosage forms. It was the purpose of this review to review the role of the initial powder feeding step in a continuous manufacturing process. Different feeding mechanisms are discussed with a particular emphasis on screw controlled loss in weight (LIW) feeding. The importance of understanding the physical properties of the raw materials and its impact on the feeding process is reviewed. Prior knowledge of materials provides an initial indication of how the powders will behave through processing and facilitates in the selection of the most suitable (i) feeder (capacity), (ii) feeding mechanism, and (iii) in the case of screw feeder - screw type. The studies identified in this review focus on the impact of material on powder feeding performance.

A Catalog of Performance Objectives, Performance Conditions, and Performance Guides for Machine Tool Operations.

ERIC Educational Resources Information Center

Stadt, Ronald; And Others

This catalog provides performance objectives, tasks, standards, and performance guides associated with current occupational information relating to the job content of machinists, specifically tool grinder operators, production lathe operators, and production screw machine operators. The catalog is comprised of 262 performance objectives, tool and…

Wedgethread pipe connection

DOEpatents

Watts, John D.

2003-06-17

Several embodiments of a wedgethread pipe connection are disclosed that have improved makeup, sealing, and non-loosening characteristics. In one embodiment, an open wedgethread is disclosed that has an included angle measured in the gap between the stab flank and the load flank to be not less than zero, so as to prevent premature wedging between mating flanks before the position of full makeup is reached, as does occur between trapped wedgethreads wherein the included angle is less than zero. The invention may be used for pipe threads large or small, as a flush joint, with collars, screwed into plates or it may even be used to reversibly connect such as solid posts to base members where a wide makeup torque range is desired. This Open wedgethread, as opposed to trapped wedgethreads, provides a threaded pipe connection that: is more cost-effective; can seal high pressure gas; can provide selectively a connection strength as high as the pipe strength; assures easy makeup to the desired position of full makeup within a wide torque range; may have a torque strength as high as the pipe torque strength; is easier to manufacture; is easier to gage; and is less subject to handling damage.

Improved Screw-Thread Lock

NASA Technical Reports Server (NTRS)

Macmartin, Malcolm

1995-01-01

Improved screw-thread lock engaged after screw tightened in nut or other mating threaded part. Device does not release contaminating material during tightening of screw. Includes pellet of soft material encased in screw and retained by pin. Hammer blow on pin extrudes pellet into slot, engaging threads in threaded hole or in nut.

Reliability of roentgenogram evaluation of pedicle screw position.

PubMed

Ferrick, M R; Kowalski, J M; Simmons, E D

1997-06-01

This was a human cadaver study of the accuracy of biplanar roentgenography in determining pedicle screw position. To determine the independent accuracy of radiologic evaluation of screw placement and to determine if there are any particular screw malpositions that are more likely to produce a false sense of acceptable screw position. Other investigators have reported the correlation between radiologic evaluation and anatomic dissection. However, in those studies the radiologic evaluation was not independent of the surgeons placing the screws. There has been no comment in the literature regarding particular screw malpositions that would lead the surgeon into a false sense of successful screw placement. Pedicle screws were placed in cadaver spines, and biplanar roentgenograms of the specimens were evaluated by independent observers. The results of the roantgenogram evaluation then were compared to those of the anatomic dissection. The accuracy of roentgenogram evaluation varied from 73% to 83%, depending on the experience of the surgeon grading the roentgenograms. Screws misplaced medially into the spinal canal are more likely to give the surgeon a false sense of successful screw placement. The surgeon must not rely solely on the roentgenograms, but instead continue to use tactile sensory skills, anatomic knowledge, and additional modalities such as electromyography monitoring.

Comparison of contemporary occipitocervical instrumentation techniques with and without C1 lateral mass screws.

PubMed

Wolfla, Christopher E; Salerno, Simon A; Yoganandan, Narayan; Pintar, Frank A

2007-09-01

This study was designed to test the kinematic properties of three occiput-C2 instrumentation constructs with and without supplemental rigid C1 fixation. The results are compared with intact specimens and with constructs incorporating contemporary cabling techniques. Five unembalmed human cadaver specimens underwent range of motion (ROM) testing in the intact condition, followed by destabilization with odontoid osteotomy. Destabilized specimens then underwent ROM testing with each of seven occipitocervical instrumentation constructs, all incorporating occipital screws: C1 and C2 sublaminar cables with cable connectors, C2 pars screws +/- C1 lateral mass screws, C2 lamina screws +/- C1 lateral mass screws, and C1-C2 transarticular screws +/- C1 lateral mass screws. All seven constructs demonstrated significantly lower ROM in all loading modes than intact specimens (P < 0.05). With a single exception, the addition of C1 lateral mass screws to the screw-based constructs produced no significant change in ROM in any of the loading modes. Compared with intact specimens, constructs anchored by C1-C2 transarticular screws demonstrated the greatest decrease in ROM, and those anchored by sublaminar cables demonstrated the least decrease in ROM. Any of the tested screw-based constructs are likely to provide adequate support for the patient with an unstable craniocervical junction. Therefore, the choice of construct should be based on anatomic considerations. The routine incorporation of C1 lateral mass screws into occipitocervical instrumentation constructs does not seem necessary.

Screw-locking wrench

NASA Technical Reports Server (NTRS)

Vranish, John M. (Inventor)

2007-01-01

A tool comprises a first handle and a second handle, each handle extending from a gripping end portion to a working end portion, the first handle having first screw threads disposed circumferentially about an inner portion of a first through-hole at the working end portion thereof, the second handle having second screw threads disposed circumferentially about an inner portion of a second through-hole at the working end portion thereof, the first and second respective through-holes being disposed concentrically about a common axis of the working end portions. First and second screw locks preferably are disposed concentrically with the first and second respective through-holes, the first screw lock having a plurality of locking/unlocking screw threads for engaging the first screw threads of the first handle, the second screw lock having a plurality of locking/unlocking screw threads for engaging the second screw threads of the second handle. A locking clutch drive, disposed concentrically with the first and second respective through-holes, engages the first screw lock and the second screw lock. The first handle and the second handle are selectively operable at their gripping end portions by a user using a single hand to activate the first and second screw locks to lock the locking clutch drive for either clockwise rotation about the common axis, or counter-clockwise rotation about the common axis, or to release the locking clutch drive so that the handles can be rotated together about the common axis either the clockwise or counter-clockwise direction without rotation of the locking clutch drive.

Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 2: Metallurgical and microhardness analysis.

PubMed

Al Jabbari, Youssef; Fournelle, Raymond; Ziebert, Gerald; Toth, Jeffrey; Iacopino, Anthony

2008-04-01

This study involved testing and analyzing multiple retrieved prosthetic retaining screws after long-term use in vivo to: (1) detect manufacturing defects that could affect in-service behavior; (2) characterize the microstructure and alloy composition; and (3) further characterize the wear mechanism of the screw threads. Two new (control) screws from Nobel Biocare (NB) and 18 used (in service 18-120 months) retaining screws [12 from NB and 6 from Sterngold (SG)] were: (1) metallographically examined by light microscopy and scanning electron microscopy (SEM) to determine the microstructure; (2) analyzed by energy dispersive X-ray (EDX) microanalysis to determine the qualitative and semiquantitative average alloy and individual phase compositions; and (3) tested for Vickers microhardness. Examination of polished longitudinal sections of the screws using light microscopy revealed a significant defect in only one Group 4 screw. No significant defects in any other screws were observed. The defect was considered a "seam" originating as a "hot tear" during original casting solidification of the alloy. Additionally, the examination of longitudinal sections of the screws revealed a uniform homogeneous microstructure in some groups, while in other groups the sections exhibited rows of second phase particles. The screws for some groups demonstrated severe deformation of the lower threads and the bottom part of the screw leading to the formation of crevices and grooves. Some NB screws were comprised of Au-based alloy with Pt, Cu, and Ag as alloy elements, while others (Groups 4 and 19) were Pd-based with Ga, Cu, and Au alloy elements. The microstructure was homogeneous with fine or equiaxed grains for all groups except Group 4, which appeared inhomogeneous with anomalous grains. SG screws demonstrated a typical dendritic structure and were Au-based alloy with Cu and Ag alloy elements. There were differences in the microhardness of gold alloy screws from NB and SG as well as palladium alloy screws from NB. Significant differences within NB retaining screws and between NB and SG screws were found for microstructure, major alloy constituents, and microhardness.

Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Amoretti, Nicolas, E-mail: amorettinicolas@yahoo.fr; Gallo, Giacomo, E-mail: giacomo.gallo83@gmail.com; Bertrand, Anne-Sophie, E-mail: asbertrand3@hotmail.com

We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation couldmore » be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.« less

The use of power tools in the insertion of cortical bone screws.

PubMed

Elliott, D

1992-01-01

Cortical bone screws are commonly used in fracture surgery, most patterns are non-self-tapping and require a thread to be pre-cut. This is traditionally performed using hand tools rather than their powered counterparts. Reasons given usually imply that power tools are more dangerous and cut a less precise thread, but there is no evidence to support this supposition. A series of experiments has been performed which show that the thread pattern cut with either method is identical and that over-penetration with the powered tap is easy to control. The conclusion reached is that both methods produce consistently reliable results but use of power tools is much faster.

Scar due to skin incision for screw fixation through the transbuccal approach after sagittal split ramus osteotomy.

PubMed

Muto, Toshitaka

2012-05-01

Most rigid fixation techniques after sagittal split ramus osteotomies of the mandible involve the transbuccal approach. A skin incision in the cheek carries with it possible undesirable sequelae, such as noticeable scarring. The aim of this study was to investigate whether there is scarring in the face after this technique. For screw insertion, a 5-mm stab incision was performed on 40 Japanese patients (20 men and 20 women) with class III occlusion. After surgery, gross examination (via the naked eyes) of the skin incision was performed monthly for 1 year by the same oral surgeon. In all cases, the skin incision had disappeared by 1 year after the surgery.

S1 screw bending moment with posterior spinal instrumentation across the lumbosacral junction after unilateral iliac crest harvest.

PubMed

Alegre, G M; Gupta, M C; Bay, B K; Smith, T S; Laubach, J E

2001-09-15

A biomechanical study comparing fixation across the lumbosacral junction. To determine which long posterior construct across the lumbosacral junction produces the least bending moment on the S1 screw when only one ilium is available for fixation. Recent in vitro studies have demonstrated the benefit of anterior support and fixation into the ilium when instrumenting a long posterior construct across the lumbosacral junction. Four L2-sacrum constructs were tested on six synthetic models of the lumbar spine and pelvis simulating that the right ilium had been harvested. Construct 1: L2-S1 bilateral screws. Construct 2: L2-S1 + left iliac bolt. Construct 3: L2-S1 + left iliac bolt + right S2 screw. Construct 4: L2-S1 + bilateral S2 screws. The four constructs were then retested with an anterior L5-S1 strut. A flexion-extension moment was applied across each construct, and the moment at the left and right S1 pedicle screw was measured with internal strain gauges. Iliac bolt fixation was found to significantly decrease the flexion-extension moment on the ipsilateral S1 screw by 70% and the contralateral screw by 26%. An anterior L5-S1 strut significantly decreased the S1 screw flexion-extension moment by 33%. Anterior support at L5-S1 provided no statistical decrease in the flexion-extension moment when bilateral posterior fixation beyond S1 was present with either a unilateral iliac bolt and contralateral S2 screw, or bilateral S2 screws. There is a significant decrease in the flexion-extension moment on the S1 screw when extending long posterior constructs to either the ilium or S2 sacral screw. There is no biomechanical advantage of the iliac bolt over the S2 screw in decreasing the moment on the S1 screw in flexion and extension. Adding anterior support to long posterior constructs significantly decreases the moment on the S1 screw. Adding distal posterior fixation to either the ilium or S2 decreases the moment on S1 screws more than adding anterior support. Further, adding anterior support when bilateral distal fixation past S1 is already present does not significantly decrease the moment on the S1 screws in flexion and extension.

Optimising implant anchorage (augmentation) during fixation of osteoporotic fractures: is there a role for bone-graft substitutes?

PubMed

Larsson, Sune; Procter, Philip

2011-09-01

When stabilising a fracture the contact between the screw and the surrounding bone is crucial for mechanical strength. Through development of screws with new thread designs, as well as optimisation of other properties, improved screw purchase has been gained. Other alternatives to improve screw fixation in osteoporotic bone, as well as normal bone if needed, includes the use of various coatings on the screw that will induce a bonding between the implant surface and the bone implant, as well as application of drugs such as bisphosphonates locally in the screw hole to induce improved screw anchorage through their anticatabolic effect on the bone tissue. As failure of internal fixation of fractures in osteoporotic bone typically occurs through breakage of the bone that surrounds the implant, rather than the implant itself, an alternative strategy in osteoporotic bone can include augmentation of the bone around the screw. This is useful when screws alone are being used for fixation, as it will increase pull-out resistance, but also when conventional plates and screws are used. In angularly stable plate-screw systems, screw back-out is not a problem if the locking mechanism between the screws and the plate works. However, augmentation that will strengthen the bone around the screws can also be useful in conjunction with angle-stable plate-screw systems, as the augmentation will provide valuable support when subjected to loading that might cause cut-out. For many years conventional bone cement, polymethylmethacrylate (PMMA), has been used for augmentation, but due to side effects--including great difficulties if removal becomes necessary--the use of PMMA has never gained wide acceptance. With the introduction of bone substitutes, such as calcium phosphate cement, it has been shown that augmentation around screws can be achieved without the drawbacks seen with PMMA. When dealing with fixation of fractures in osteoporotic bone where screw stability might be inadequate, it therefore seems an attractive option to include bone substitutes for augmentation around screws as part of the armamentarium. Clinical studies now are needed to determine the indications in which bone augmentation with bone-graft substitutes (BGSs) would merit clinical usage. Copyright © 2011. Published by Elsevier Ltd.

Surgical treatment of sagittal fracture of mandibular condyle using long-screw osteosynthesis.

PubMed

Luo, Shufang; Li, Bo; Long, Xing; Deng, Mohong; Cai, Hengxing; Cheng, Yong

2011-07-01

The retrospective study evaluated long-screw (bicortical screw) osteosynthesis used in the surgical treatment of sagittal fracture of the mandibular condyle and compared it with titanium plates and removal of the condylar fragment. Ninety-five patients with sagittal fracture of the mandibular condyle received open surgical treatment from 1997 to 2008. Among these patients, the condylar fragments were fixed with long screws in 56 cases (group A), were fixed with titanium plates in 12 cases (group B), and were completely removed in 24 cases (group C). Follow-up was carried out clinically and radiologically. The clinical features included limitation of mandibular mobility, occlusion disturbance, lateral deviation on mouth opening, joint pain, clicking, facial asymmetry, and patient's subjective evaluation. The radiologic parameters consisted of degree of bony resorption, bony change, change of osteosynthesis material, and shortening of mandibular ramus height. Anatomic reduction and functional restoration were obtained and no severe complication was detected in group A. However, 3 of 14 patients had severe osteoarthrosis and 2 of 14 patients had ankylosis in group B. In group C 3 of 24 patients had mandibular retrusion, 4 of 24 patients had front teeth open bite, 4 of 24 patients had severe osteoarthrosis, and 1 of 24 patients had ankylosis. The long-screw fixation group had a more favorable prognosis than the titanium plate group and the group in which removal of the condylar fragment was performed. The long-screw fixation technique might be suitable for use in the surgical treatment of sagittal fractures of the mandibular condyle. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures.

PubMed

2014-06-26

Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813).

Feasibility of Modified Anterior Odontoid Screw Fixation: Analysis of a New Trajectory Using 3-Dimensional Simulation Software.

PubMed

Zhang, Li-Lian; Chen, Qi; Wang, Hao-Li; Xu, Hua-Zi; Tian, Nai-Feng

2018-05-03

Anterior odontoid screw fixation (AOSF) has been suggested as the optimal treatment for type II and some shallow type III odontoid fractures. However, only the classical surgical trajectory is available; no newer entry points or trajectories have been reported. We evaluated the anatomic feasibility of a new trajectory for AOSF using 3-dimensional (3D) screw insertion simulation software (Mimics). Computed tomography (CT) scans of patients (65 males and 59 females) with normal cervical structures were obtained consecutively, and the axes were reconstructed in 3 dimensions by Mimics software. Then simulated operations were performed using 2 new entry points below the superior articular process using bilateral screws of different diameters (group 1: 4 mm and 4 mm; group 2: 4 mm and 3.5 mm; group 3: 3.5 mm and 3.5 mm). The success rates and the required screw lengths were recorded and analyzed. The success rates were 79.03% for group 1, 95.16% for group 2, and 98.39% for group 3. The success rates for groups 2 and 3 did not differ significantly, and both were significantly better than the rate for group 1. The success rate was much higher in males than in females in group 1, but the success rate was similar in males and females in the other 2 groups. Screw lengths did not differ significantly among the 3 groups, but an effect of sex was apparent. Our modified trajectory is anatomically feasible for fixation of anterior odontoid fractures, but further anatomic experiments and clinical research are needed. Copyright © 2018 Elsevier Inc. All rights reserved.

Comparison of oil refining and biodiesel production process between screw press and n-hexane techniques from beauty leaf feedstock

NASA Astrophysics Data System (ADS)

Bhuiya, M. M. K.; Rasul, M. G.; Khan, M. M. K.; Ashwath, N.

2016-07-01

The Beauty Leaf Tree (Callophylum inophyllum) is regarded as an alternative source of energy to produce 2nd generation biodiesel due to its potentiality as well as high oil yield content in the seed kernels. The treating process is indispensable during the biodiesel production process because it can augment the yield as well as quality of the product. Oil extracted from both mechanical screw press and solvent extraction using n-hexane was refined. Five replications each of 25 gm of crude oil for screw press and five replications each of 25 gm of crude oil for n-hexane were selected for refining as well as biodiesel conversion processes. The oil refining processes consists of degumming, neutralization as well as dewaxing. The degumming, neutralization and dewaxing processes were performed to remove all the gums (phosphorous-based compounds), free fatty acids, and waxes from the fresh crude oil before the biodiesel conversion process carried out, respectively. The results indicated that up to 73% and 81% of mass conversion efficiency of the refined oil in the screw press and n-hexane refining processes were obtained, respectively. It was also found that up to 88% and 90% of biodiesel were yielded in terms of mass conversion efficiency in the transesterification process for the screw press and n-hexane techniques, respectively. While the entire processes (refining and transesterification) were considered, the conversion of beauty leaf tree (BLT) refined oil into biodiesel was yielded up to 65% and 73% of mass conversion efficiency for the screw press and n-hexane techniques, respectively. Physico-chemical properties of crude and refined oil, and biodiesel were characterized according to the ASTM standards. Overall, BLT has the potential to contribute as an alternative energy source because of high mass conversion efficiency.

Self-Reinforced Biodegradable Screw Fixation Compared With Titanium Screw Fixation in Mandibular Advancement

PubMed Central

Turvey, Timothy A.; Bell, R. Bryan; Phillips, Ceib; Proffit, William R.

2013-01-01

Purpose This report compares the skeletal stability and treatment outcomes of 2 similar cohorts undergoing bilateral sagittal osteotomies of the mandible for advancement. The study groups included patients stabilized with 2-mm self-reinforced polylactate (PLLDL 70/30), biodegradable screws (group B), and 2-mm titanium screws placed in a positional fashion (group T). Materials and Methods Sixty-nine patients underwent bilateral sagittal osteotomies of the mandibular ramus for advancement utilizing an identical technique. There were 34 patients in group B and 35 patients in group T. Each patient had preoperative, immediate postoperative, splint out, and 1-year postoperative cephalometric radiographs available for analysis. The method of analysis and treatment outcomes parameters are identical to those previously used. Repeated measures analysis of variance was performed with means of fixation as the between-subject factor and time as the within subject factor. The level of significance was set at .01. Results There were no clinical failures in group T and a single failure in group B. The average difference in stability between the groups is small and subtly different at the mandibular angle. The data documented similarity of the postsurgical changes in the 2 groups with the only statistically significant difference being the vertical position of the gonion (P < .001) and the mandibular plane angle (P < .01) with greater upward remodeling at gonion in group T. Conclusions Two-mm self-reinforced PLLDL (70/30) screws can be used as effectively as 2-mm titanium screws to stabilize the mandible after bilateral sagittal osteotomies for mandibular advancement. The difference in 1-year stability and outcome is minimal. PMID:16360855

Development of an in-line Raman spectroscopic method for continuous API quantification during twin-screw wet granulation.

PubMed

Harting, Julia; Kleinebudde, Peter

2018-04-01

Raman spectroscopy was evaluated as a process analytical technology (PAT) tool for continuous API quantification during twin-screw wet granulation. Therefore, a Raman probe was implemented in front of the granulator barrel. This setup enabled the collection of Raman spectra upon a constant granule flow. To develop an in-line PLS calibration model, eight binary mixtures of the API and lactose monohydrate with API contents between 5 and 50% were pre-blended and granulated in a twin-screw granulator with a screw speed of 150 rpm and a powder feed rate of 40 g/min. Water was used as a granulation liquid with different liquid to solid ratios depending on the API content. Ibuprofen and diclofenac sodium were chosen as model drugs and separated PLS models were built for each API. The predictive performance of the developed PLS models was determined by granulating and monitoring new test samples containing different API concentrations. This evaluation showed that the models were able to predict the API concentration with an RMSEP of 0.59% for ibuprofen and 1.5% for diclofenac sodium. In a second part, the developed in-line Raman spectroscopic method was used to determine the API concentration during a split feeding process. Therefore, the API and lactose monohydrate were added by two independently adjustable feeders into the twin-screw granulator barrel. The in-line spectroscopy analysis which was verified by UV-analysis indicated that the mixing ability of the twin-screw granulator was good for the used settings and all adjusted API concentrations. Copyright © 2018 Elsevier B.V. All rights reserved.

Inter- and intra-observer reliability of measurement of pedicle screw breach assessed by postoperative CT scans.

PubMed

Lavelle, William F; Ranade, Ashish; Samdani, Amer F; Gaughan, John P; D'Andrea, Linda P; Betz, Randal R

2014-01-01

Pedicle screws are used increasingly in spine surgery. Concerns of complications associated with screw breach necessitates accurate pedicle screw placement. Postoperative CT imaging helps to detect screw malposition and assess its severity. However, accuracy is dependent on the reading of the CT scans. Inter- and intra-observer variability could affect the reliability of CT scans to assess multiple screw types and sites. The purpose of this study was to assess the reliability of multi-observer analysis of CT scans for determining pedicle screw breach for various screw types and sites in patients with spinal deformity or degenerative pathologies. Axial CT scan images of 23 patients (286 screws) were read by four experienced spine surgeons. Pedicle screw placement was considered 'In' when the screw was fully contained and/or the pedicle wall breach was ≤2 mm. 'Out' was defined as a breach in the medial or lateral pedicle wall >2 mm. Intra-class coefficients (ICC) were calculated to assess the inter- and intra-observer reliability. Marked inter- and intra-observer variability was noticed. The overall inter-observer ICC was 0.45 (95% confidence limits 0.25 to 0.65). The intra-observer ICC was 0.49 (95% confidence limits 0.29 to 0.69). Underlying spinal pathology, screw type, and patient age did not seem to impact the reliability of our CT assessments. Our results indicate the evaluation of pedicle screw breach on CT by a single surgeon is highly variable, and care should be taken when using individual CT evaluations of millimeters of breach as a basis for screw removal. This was a Level III study.

The effects of loading on the preload and dimensions of the abutment screw for a 3-unit cantilever-fixed prosthesis design.

PubMed

Setia, Gaurav; Yousef, Hoda; Ehrenberg, David; Luke, Allyn; Weiner, Saul

2013-08-01

The purpose of this study was to use an in vitro model system to compare the effects on the screw torque and screw dimensions within 2 commercially available implant systems from occlusal loading on a cantilevered-fixed partial denture. Cantilevered implant-supported 3-unit prostheses with 2 premolar abutments and 1 premolar pontic (7.3 mm in length) were made on resin casts containing 2 implant analogs for 2 implant systems: BioLok Silhouette Tapered Implant System (Birmingham, AL) and Zimmer Tapered Screw-Vent Implant System (Carlsbad, CA) with 10 samples in each group. Each sample was loaded with either of 2 protocols: (1) a load of 50 N on the cantilevered pontic unit and (2) a loading of 150 N on all 3 units. The outcome measures were (1) changes in residual torque of the abutment screws and (2) changes in screw dimension. The BioLok Silhouette Tapered Implant group demonstrated slight but statistically significant torque loss 18.8% to 28.5% in both abutment screws for both protocols, P ≤ 0.05, without any changes in screw dimension. In the Zimmer Tapered Screw-Vent Implant group, there was a significant elongation of the abutment screws and a markedly significant 44.4%, (P ≤ 0.01) loss in torque in the mesial screw and a 28.5%, (P ≤ 0.05) loss in torque in the distal screw when the cantilever alone was loaded. Differences in screw design influence the maintenance of preload and distortion of the shank. The influence of the interface design, namely an internal hex of 1 mm versus an external hex did not influence the preload. Cantilevered prostheses can cause loss of torque and dimensional changes in abutment screws.

Effect of Off-Axis Screw Insertion, Insertion Torque, and Plate Contouring on Locked Screw Strength

PubMed Central

Gallagher, Bethany; Silva, Matthew J.; Ricci, William M.

2015-01-01

Objectives This study quantifies the effects of insertion torque, off-axis screw angulation, and plate contouring on the strength of locking plate constructs. Methods Groups of locking screws (n = 6–11 screws) were inserted at 50%, 100%, 150%, and 200% of the manufacturer-recommended torque (3.2 Nm) into locking compression plates at various angles: orthogonal (control), 5-degree angle off-axis, and 10-degree angle off-axis. Screws were loaded to failure by a transverse force (parallel to the plate) either in the same (“+”) or opposite direction (“−”) of the initial screw angulation. Separately, locking plates were bent to 5 and 10-degree angles, with the bend apex at a screw hole. Locking screws inserted orthogonally into the apex hole at 100% torque were loaded to failure. Results Orthogonal insertion resulted in the highest average load to failure, 2577 ± 141 N (range, 2413–2778 N), whereas any off-axis insertion significantly weakened constructs (165–1285 N, at 100% torque) (P < 0.05). For “+” loading, torque beyond 100% did not increase strength, but 50% torque reduced screw strength (P < 0.05). Loading in the “−” direction consistently resulted in higher strengths than “+” loading (P < 0.05). Plate contouring of 5-degree angle did not significantly change screw strength compared with straight plates but contouring of 10-degree angle significantly reduced load to failure (P < 0.05). Conclusions To maximize the screw plate interface strength, locking screws should be inserted without cross-threading. The mechanical stability of locked screws is significantly compromised by loose insertion, off-axis insertion, or severe distortion of the locking mechanism. PMID:24343255

Perforations and angulations of 324 cervical medial cortical pedicle screws: a possible guide to avoid lateral perforations with use of pedicle screws in lower cervical spine.

PubMed

Mahesh, Bijjawara; Upendra, Bidre; Vijay, Sekharappa; Arun, Kumar; Srinivasa, Reddy

2017-03-01

More than half of the perforations reported with usage of cervical pedicle screws (CPS) are lateral perforations, endangering the vertebral artery. The medial cortical pedicle screw (MCPS) technique with partial drilling of the medial cortex shifts the trajectory of pedicle screws medially, decreasing the lateral perforations. To evaluate the decrease in lateral perforations of CPS with use of MCPS technique, in relation to medial angulation. Retrospective analysis and technical report of the MCPS technique and its safety. A total of 58 patients operated on between December 2011 and May 2015 with insertion of pedicle screws from C3 to C7 were included in the study. Axial reconstructed computed tomography (CT) scan images of the inserted screws were evaluated for placement, perforations, and transverse plane angulations using the Surgimap software (Surgimap Spine 1.1.2.271 Intl. 2009 Nemaris LLC). The angulations of screws were analyzed by the type and level of placement through unpaired t test and analysis of variance test. A total of 58 patients operated on between December 2011 and May 2015 with insertion of pedicle screws from C3 to C7 were included in the study. There were 49 males and 9 females. Thirty-seven patients had cervical trauma, 17 had cervical spondylotic myelopathy, two had tumors, and two had ankylosing spondylitis. The average age was 49 years (range 18 to 80 years). The screws were inserted using the MCPS technique. All patients underwent postoperative CT scans with GE Optima CT540 16 slice CT scanner (GE Healthcare Chalfont St. Giles, Buckinghamshire, UK). Axial reconstructed images along the axis of the inserted screws were evaluated for placement and perforations. Further, all the screws were evaluated for transverse plane angulations using the Surgimap software. The angulations of screw were analyzed by the type and level of placement through unpaired t test and analysis of variance test. No funds were received by any of the authors for the purpose of the present study. A total of 324 screws were assessed with postoperative CT scans. Two hundred fifty-six were found to be placed within the pedicle and 68 (20.98%) screws were found to have perforations. Forty screws (12.34%) had grade I medial perforations, 14 screws (4.32%) had grade I lateral perforations, 10 screws (3.08%) had grade II medial perforations, and 4 screws (1.23%) had grade IIlateral perforations. The average angulation of the nonperforated screws (n=256) was 28.6° (43°-17°), that of laterally perforated screws was 20.33° (13°-24°), and that of the medially perforated screws was 34.94° (45°-20°). On statistical analysis with each series, the 99% CI range for the in-screw angles was 27.91° to 29.34°; for the laterally perforated screw series, it was 18.42° to 22.23°; and that for the medially perforated screw series was 32.97° to 36.9°. The MCPS technique represents a shift in the concept of placement of CPS from the cancellous core to the medial cortex, avoiding screw deflection laterally by the thick proximal medial cortex. The present study shows that the lateral perforations can be consistently avoided, with a medial angulation of more than 27.91°, which is the primary concern with the use of pedicle screws in lower cervical spine. Further, the MCPS technique reduces the lateral perforations at a lesser insertion angle, which is technically desirable. Copyright © 2016 Elsevier Inc. All rights reserved.

The effect of load obliquity on the strength of locking and nonlocking constructs in synthetic osteoporotic bone.

PubMed

Tensmeyer, Daniel F; Gustafson, Peter A; Jastifer, James R; Patel, Bipin; Chess, Joseph L

2015-11-01

The biomechanical performance of internal fracture fixation depends on several factors. One measure of performance is the strength of the construct. The objective of this biomechanical study was to identify the effect of load obliquity on the strength of locking and nonlocking plate and screw constructs. For this study, plates and screws were fixed to synthetic osteoporotic bone that had a 1 mm thick synthetic cortical shell. An 8-hole, 3.5 mm thick hybrid plate was fixed with either two 3.5 mm major diameter locking screws or two 4.0 mm major diameter cancellous screws. Forces were applied at 0, 45, and 90 degrees to the plate normal. Eight specimens were loaded to failure for each group. When loads were applied normal to the plate, the nonlocking construct failed initially at higher loads (123.2 ± 13.2 N) than the locking construct (108.7 ± 7.6 N, P = 0.020). For oblique loads, the locking construct failed at higher mean loads but the difference of means was not statistically significant (167.7 ± 14.9 N compared to 154.2 ± 9.4 N, P = 0.052). For loads parallel to the plate, the locking construct was much stronger than the nonlocking construct (1591 ± 227 N compared to 913 ± 237 N, P < 0.001). Stiffness and Energy outcomes are also compared. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Incidence and clinical outcomes of tendon rupture following distal radius fracture.

PubMed

White, Brian D; Nydick, Jason A; Karsky, Dawnne; Williams, Bailee D; Hess, Alfred V; Stone, Jeffrey D

2012-10-01

To evaluate the incidence of tendon rupture after nonoperative and operative management of distal radius fractures, report clinical outcomes after tendon repair or transfer, and examine volar plate and dorsal screw prominence as a predictor of tendon rupture. We performed a retrospective chart review on patients treated for tendon rupture after distal radius fracture. We evaluated active range of motion, Disabilities of Arm, Shoulder, and Hand score, grip strength, and pain score, and performed radiographic evaluation of volar plate and dorsal screw prominence in both the study group and a matched control group. There were 6 tendon ruptures in 1,359 patients (0.4%) treated nonoperatively and 8 tendon ruptures in 999 patients (0.8%) treated with volar plate fixation. At the time of final follow-up, regardless of treatment, we noted that patients had minimal pain and excellent motion and grip strength. Mean Disabilities of the Shoulder, Arm, and Hand scores were 6 for patients treated nonoperatively and 4 for those treated with volar plating. We were unable to verify volar plate or dorsal screw prominence as independent risk factors for tendon rupture after distal radius fractures. However, we recommend continued follow-up and plate removal for symptomatic patients who have volar plate prominence or dorsal screw prominence. In the event of tendon rupture, we report excellent clinical outcomes after tendon repair or tendon transfer. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Survival of two post systems--five-year results of a randomized clinical trial.

PubMed

Schmitter, Marc; Hamadi, Khaled; Rammelsberg, Peter

2011-01-01

To assess the survival rate of two different post systems after 5 years of service with a prospective randomized controlled trial. One hundred patients in need of a post were studied. Half of the patients received long glass fiber-reinforced posts, while the other half received long metal screw posts. The posts were assigned randomly. After at least 5 years (mean, 61.37 months), follow-ups were established. When a complication occurred prior to this recall, the type and time of the complication was documented. Statistical analysis was performed using the log-rank test and Kaplan-Meier analysis. Additionally, a Cox regression was performed to analyze risk factors. The survival rate of fiber-reinforced posts was 71.8%. In the metal screw post group, the survival rate was significantly lower, 50.0% (log-rank test, P = .026). Metal posts resulted more often in more unfavorable complications (eg, root fractures); consequently, more teeth (n = 17) had to be extracted. The Cox regression identified the following risk factors: position of the tooth (anterior vs posterior teeth), degree of coronal tooth destruction, and the post system (fiber-reinforced post vs metal screw post). Fiber-reinforced restorations loosened in several patients; in some of these cases (n = 6), patients did not notice this, leading to the extraction of teeth. Long metal screw posts should be used with great care in endodontically treated teeth. Besides the selection of the post system, other factors influence the survival of the restoration.

A CFD study of Screw Compressor Motor Cooling Analysis

NASA Astrophysics Data System (ADS)

Branch, S.

2017-08-01

Screw compressors use electric motors to drive the male screw rotor. They are cooled by the suction refrigerant vapor that flows around the motor. The thermal conditions of the motor can dramatically influence the performance and reliability of the compressor. The more optimized this flow path is, the better the motor performance. For that reason it is important to understand the flow characteristics around the motor and the motor temperatures. Computational fluid dynamics (CFD) can be used to provide a detailed analysis of the refrigerant’s flow behavior and motor temperatures to identify the undesirable hot spots in the motor. CFD analysis can be used further to optimize the flow path and determine the reduction of hot spots and cooling effect. This study compares the CFD solutions of a motor cooling model to a motor installed with thermocouples measured in the lab. The compressor considered for this study is an R134a screw compressor. The CFD simulation of the motor consists of a detailed breakdown of the stator and rotor components. Orthotropic thermal conductivity material properties are used to represent the simplified motor geometry. In addition, the analysis includes the motor casings of the compressor to draw heat away from the motor by conduction. The study will look at different operating conditions and motor speeds. Finally, the CFD study will investigate the predicted motor temperature change by varying the vapor mass flow rates and motor speed. Recommendations for CFD modeling of such intricate heat transfer phenomenon have thus been proposed.

Clinical Performance of One-Piece, Screw-Retained Implant Crowns Based on Hand-Veneered CAD/CAM Zirconia Abutments After a Mean Follow-up Period of 2.3 Years.

PubMed

Schnider, Nicole; Forrer, Fiona Alena; Brägger, Urs; Hicklin, Stefan Paul

The aim of this study was to evaluate the clinical performance of one-piece, screw-retained implant crowns based on hand-veneered computer-aided design/computer-aided manufacture (CAD/CAM) zirconium dioxide abutments with a crossfit connection at least 1 year after insertion of the crown. Consecutive patients who had received at least one Straumann bone level implant and one-piece, screw-retained implant crowns fabricated with CARES zirconium dioxide abutments were reexamined. Patient satisfaction, occlusal and peri-implant parameters, mechanical and biologic complications, radiologic parameters, and esthetics were recorded. A total of 50 implant crowns in the anterior and premolar region were examined in 41 patients. The follow-up period of the definitive reconstructions ranged from 1.1 to 3.8 years. No technical and no biologic complications had occurred. At the reexamination, 100% of the implants and reconstructions were in situ. Radiographic evaluation revealed a mean distance from the implant shoulder to the first visible bone-to-implant contact of 0.06 mm at the follow-up examination. Screw-retained crowns based on veneered CAD/CAM zirconium dioxide abutments with a crossfit connection seem to be a promising way to replace missing teeth in the anterior and premolar region. In the short term, neither failures of components nor complications were noted, and the clinical and radiographic data revealed stable hard and soft tissue conditions.

Evaluation of the use of intra-operative radiology for open placement of lag screws for the stabilization of sacroiliac luxation in cats.

PubMed

Silveira, Francisco; Quinn, Robert J; Adrian, Anna M; Owen, Martin R; Bush, Mark A

2017-01-16

To assess the effect of intra-operative radiology on the quality of lag screw insertion for the management of sacroiliac joint luxations in cats. In this retrospective single-centre study, the surgical, anaesthetic and imaging records of 40 screws (32 cats) placed with lag effect for management of sacroiliac luxation were reviewed. Postoperative radiographs were assessed for sacroiliac joint reduction, screw position, and sacral width purchased by each screw. Cases were divided into two groups according to the use of (IOR) or the absence of intra-operative radiology (NIOR). A total of 23 lag screws were placed with the aid of intra-operative radiology and 17 without. Three of the 23 screws placed in the IOR group exited the sacrum as opposed to eight of 17 screws in the NIOR group (p = 0.03). Mean sacral width purchased by the screws in the IOR group (70.8%) was also significantly higher (p = 0.002) than in the NIOR group (54.6%). Mean general anaesthetic times for unilateral and bilateral screw placement for the IOR group and NIOR group were not significantly different. The use of intra-operative radiology can significantly improve the quality of lag screw insertion for the stabilization of sacroiliac luxations in cats, which should lead to a reduced incidence of postoperative screw loosening.

Effect of cement washout on loosening of abutment screws and vice versa in screw- and cement- retained implant-supported dental prosthesis

PubMed Central

Kim, Seok-Gyu; Son, Mee-Kyoung

2015-01-01

PURPOSE The purpose of this study was to examine the abutment screw stability of screw- and cement-retained implant-supported dental prosthesis (SCP) after simulated cement washout as well as the stability of SCP cements after complete loosening of abutment screws. MATERIALS AND METHODS Thirty-six titanium CAD/CAM-made implant prostheses were fabricated on two implants placed in the resin models. Each prosthesis is a two-unit SCP: one screw-retained and the other cemented. After evaluating the passive fit of each prosthesis, all implant prostheses were randomly divided into 3 groups: screwed and cemented SCP (Control), screwed and noncemented SCP (Group 1), unscrewed and cemented SCP (Group 2). Each prosthesis in Control and Group 1 was screwed and/or cemented, and the preloading reverse torque value (RTV) was evaluated. SCP in Group 2 was screwed and cemented, and then unscrewed (RTV=0) after the cement was set. After cyclic loading was applied, the postloading RTV was measured. RTV loss and decementation ratios were calculated for statistical analysis. RESULTS There was no significant difference in RTV loss ratio between Control and Group 1 (P=.16). No decemented prosthesis was found among Control and Group 2. CONCLUSION Within the limits of this in vitro study, the stabilities of SCP abutment screws and cement were not significantly changed after simulated cement washout or screw loosening. PMID:26140172

Arthroscopic Latarjet Techniques: Graft and Fixation Positioning Assessed With 2-Dimensional Computed Tomography Is Not Equivalent With Standard Open Technique.

PubMed

Neyton, Lionel; Barth, Johannes; Nourissat, Geoffroy; Métais, Pierre; Boileau, Pascal; Walch, Gilles; Lafosse, Laurent

2018-05-19

To analyze graft and fixation (screw and EndoButton) positioning after the arthroscopic Latarjet technique with 2-dimensional computed tomography (CT) and to compare it with the open technique. We performed a retrospective multicenter study (March 2013 to June 2014). The inclusion criteria included patients with recurrent anterior instability treated with the Latarjet procedure. The exclusion criterion was the absence of a postoperative CT scan. The positions of the hardware, the positions of the grafts in the axial and sagittal planes, and the dispersion of values (variability) were compared. The study included 208 patients (79 treated with open technique, 87 treated with arthroscopic Latarjet technique with screw fixation [arthro-screw], and 42 treated with arthroscopic Latarjet technique with EndoButton fixation [arthro-EndoButton]). The angulation of the screws was different in the open group versus the arthro-screw group (superior, 10.3° ± 0.7° vs 16.9° ± 1.0° [P < .001]; inferior, 10.3° ± 0.8° vs 15.7° ± 0.9° [P < .0001]). The angulation of the EndoButtons was 5.7° ± 0.5°; this was different from that of open inferior screws (P = .003). In the axial plane (level of equator), the arthroscopic techniques resulted in lateral positions (arthro-screw, 1.5 ± 0.3 mm lateral [P < .001]; arthro-EndoButton, 0 ± 0.3 mm lateral [P < .0001]) versus the open technique (0.9 ± 0.2 mm medial). At the level of 25% of the glenoid height, the arthroscopic techniques resulted in lateral positions (arthro-screw, 0.3 ± 0.3 mm lateral [P < .001]); (arthro-EndoButton, 0.7 ± 0.3 mm lateral [P < .0001]) versus the open technique (1.0 ± 0.2 mm medial). Higher variability was observed in the arthro-screw group. In the sagittal plane, the arthro-screw technique resulted in higher positions (55% ± 3% of graft below equator) and the arthro-EndoButton technique resulted in lower positions (82% ± 3%, P < .0001) versus the open technique (71% ± 2%). Variability was not different. This study shows that the position of the fixation devices and position of the bone graft with the arthroscopic techniques are statistically significantly different from those with the open technique with 2-dimensional CT assessment. In the sagittal plane, the arthro-screw technique provides the highest positions, and the arthro-EndoButton technique, the lowest. Overall, the mean position of the bone block with the open Latarjet technique in the axial plane is slightly medial to the joint line, as recommended. Conversely, with the arthroscopic techniques, the bone grafts are more lateral with a slight overhang. The main differences are observed in the dispersion of the values (more extreme positions) with the arthro-screw technique, given the acknowledged limitations. Despite the statistical significance, the clinical significance of these differences is yet unknown. Level III, retrospective comparative study. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Use of C2 spinous process screw for posterior cervical fixation as substitute for laminar screw in a patient with thin laminae

PubMed Central

Nagata, Kosei; Baba, Satoshi; Chikuda, Hirotaka; Takeshita, Katsushi

2013-01-01

Rigid screw fixation of C2 including transarticular screw and pedicle screw contain the risk of vertebral artery (VA) injury. On the other hand, translaminar screws are considered to be safer for patients with anomalous VA. But C2 translaminar screw placement was limited in patients who have thin laminas and there is marked variation in C2 laminar thickness. Appropriate C2 fixation method for a patient who has thin laminas and high-riding VA together was controversial. Here, we present a case of an elderly Asian woman who had thin laminas and high-riding VA together with progressive myelopathy to report a first case of C2 spinous process screw insertion. Although the stability and safety of C2 spinous process screw was reported in cadaver series, there was no clinical report to our knowledge. Spinous process screw can be an option of C2 fixation for patients with high-riding VA and severe degenerated cervical spines including thin C2 laminas. PMID:23814004

Reverse Anterior Cruciate Ligament Reconstruction Fixation: A Biomechanical Comparison Study of Tibial Cross-Pin and Femoral Interference Screw Fixation.

PubMed

Lawley, Richard J; Klein, Samuel E; Chudik, Steven C

2017-03-01

To evaluate the biomechanical performance of tibial cross-pin (TCP) fixation relative to femoral cross-pin (FCP), femoral interference screw (FIS), and tibial interference screw (TIS) fixation. We randomized 40 porcine specimens (20 tibias and 20 femurs) to TIS fixation (group 1, n = 10), FIS fixation (group 2, n = 10), TCP fixation (group 3, n = 10), or FCP fixation (group 4, n = 10) and performed biomechanical testing to compare ultimate load, stiffness, yield load, cyclic displacement, and load at 5-mm displacement. We performed cross-pin fixation of the looped end and interference screw fixation of the free ends of 9-mm-diameter bovine extensor digitorum communis tendon grafts. Graft fixation constructs were cyclically loaded and then loaded to failure in line with the tunnels. Regarding yield load, FIS was superior to TIS (704 ± 125 N vs 504 ± 118 N, P = .002), TCP was superior to TIS (1,449 ± 265 N vs 504 ± 118 N, P < .001), and TCP was superior to FCP (1,449 ± 265 N vs 792 ± 397 N, P < .001). Cyclic displacement for FCP was superior to TCP. Cyclic displacement for TIS versus FIS showed no statistically significant difference (2.5 ± 1.0 mm vs 2.2 ± 0.6 mm, P = .298). Interference screw fixation consistently failed by graft slippage, whereas TCP fixation failed by tibial bone failure. FCP fixation failed by either femoral bone failure or failure elsewhere in the testing apparatus. Regarding yield load, TCP fixation performed biomechanically superior to the clinically proven FCP at time zero. Because TIS fixation shows the lowest yield strength, it represents the weak link, and combined TCP-FIS fixation theoretically would be biomechanically superior relative to combined FCP-TIS fixation with regard to yield load. Cyclic displacement showed a small difference in favor of FCP over TCP fixation and no difference between TIS and FIS. Time-zero biomechanics of TCP fixation paired with FIS fixation show that this method of fixation can be considered a potential alternative to current practice and may pose clinical benefits in different clinical scenarios of anterior cruciate ligament reconstruction. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Does higher screw density improve radiographic and clinical outcomes in adolescent idiopathic scoliosis? A systematic review and pooled analysis.

PubMed

Luo, Ming; Wang, Wengang; Shen, Mingkui; Luo, Xin; Xia, Lei

2017-04-01

OBJECTIVE The radiographic and clinical outcomes of low-density (LD) versus high-density (HD) screw constructs in patients with adolescent idiopathic scoliosis (AIS) treated with all-pedicle screw constructs are still controversial. A systematic review and pooled analysis were performed to compare radiographic, perioperative, and quality-of-life (QOL) outcomes and complications in patients with moderate AIS treated with LD or HD screw constructs. METHODS The MEDLINE, Embase, and Web of Science databases were searched for English-language articles addressing LD versus HD screw constructs in AIS patients treated with all-pedicle screw constructs. The division of LD and HD groups was based on relative screw density and screw techniques. This systematic analysis strictly followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and all articles included in the analysis met the criteria specified in the guidelines. Two reviewers independently assessed the quality of the studies using the Newcastle-Ottawa Scale. Date on radiographic, perioperative, and QOL outcomes and complications were extracted from the included studies. RESULTS Twelve studies, involving a total of 827 patients (480 treated with LD constructs, 347 with HD), were analyzed-1 randomized controlled trial, 1 quasi-randomized controlled trial, and 10 retrospective studies. The patients' age at surgery, preoperative Cobb angle of the major curve, amount of thoracic kyphosis, and major curve flexibility were reasonably distributed, and no statistically significant differences were found. Regarding the outcomes at most recent follow-up, there were no significant differences in the Cobb angle of the major curve (mean difference 0.96°, 95% CI -0.06° to 1.98°, p = 0.06, I 2 = 1%), major curve correction (mean difference -0.72%, 95% CI -2.96% to 1.52%, p = 0.53, I 2 = 0%), thoracic kyphosis (mean difference -1.67°, 95% CI -4.59° to 1.25°, p = 0.26, I 2 = 79%), complications (odds ratio [OR] 0.66, 95% CI 0.31-1.42, p = 0.29, I 2 = 0%), and QOL outcomes. Reduced operative time (mean difference -48.56 minutes, 95% CI -82.69 to -14.43 minutes, p = 0.005, I 2 = 87%), blood loss (mean difference -77.85 ml, 95% CI -153.10 to -2.60 ml, p = 0.04, I 2 = 0%), and hospital charges (mean difference -$5.92K, 95% CI -$6.59K to -$5.26K, p < 0.00001, I 2 = 0%) were found in the LD group, compared with the HD group. CONCLUSIONS LD and HD screw constructs are both associated with satisfactory radiographic and QOL outcomes with few complications. This study supports the use of LD screw constructs for the treatment of moderate AIS, because they resulted in reduced operative time, blood loss, and hospital charges while maintaining radiographic and QOL outcomes and complication rates similar to those achieved with HD screw constructs.

Thoracic pedicle classification determined by inner cortical width of pedicles on computed tomography images: its clinical significance for posterior vertebral column resection to treat rigid and severe spinal deformities-a retrospective review of cases.

PubMed

Zhang, Ying; Xie, Jingming; Wang, Yingsong; Bi, Ni; Zhao, Zhi; Li, Tao

2014-08-13

Posterior vertebral column resection (PVCR) is an effective alternative for treating rigid and severe spinal deformities. Accurate placement of pedicle screws, especially apically, is crucial. As morphologic evaluations of thoracic pedicles have not provided objective criteria, we propose a thoracic pedicle classification for treating rigid and severe spinal deformities. A consecutive series of 56 patients with severe and rigid spinal deformities who underwent PVCR at a single institution were reviewed retrospectively. Altogether, 1098 screws were inserted into thoracic pedicles at T2-T12. Based on the inner cortical width of the thoracic pedicles, the patients were divided into four groups: group 1 (0-1.0 mm), group 2 (1.1-2.0 mm), group 3 (2.1-3.0 mm), group 4 (≥3.1 mm). The proportion of screws accurately inserted in thoracic pedicles for each group was calculated. Statistical analysis was also performed regarding types of thoracic pedicles classified by Lenke et al. (SPINE 35:1836-1842, 2010) using a morphological method. There were statistically significant differences in the rates of screws inserted in thoracic pedicles between the groups (P < 0.008) except groups 3 and 4 (P > 0.008), which were then combined. The accuracies for the three new groups were 35.05%, 65.34%, and 88.32%, respectively, with statistically significant differences between the groups (P < 0.017). Rates of screws inserted in thoracic pedicles classified by Lenke et al. (SPINE 35:1836-1842, 2010) were 82.31%, 83.40%, 80.00%, and 30.28% for types A, B, C, and D, respectively. There was no statistically significant difference (P > 0.008) between these types except between type D and the other three types (P < 0.008). The inner cortical width of thoracic pedicles is the sole factor crucial for accurate placement of thoracic pedicle screws. We propose a computed tomography-based classification of the pedicle's inner cortical width: type I thoracic pedicle: absent channel, inner cortical width of 0-1 mm; type II: presence of a channel of which type IIa has an inner cortical width of 1.1-2.0 mm and type IIb a width of ≥2.1 mm. The proposed classification can help surgeons predict whether screws can be inserted into the thoracic pedicle, thus guiding instrumentation when PVCR is performed.

Design of internal screw thread measuring device based on the Three-Line method principle

NASA Astrophysics Data System (ADS)

Hu, Dachao; Chen, Jianguo

2010-08-01

In accordance with the principle of Three-Line, this paper analyze the correlation of every main parameter of internal screw thread, and then designed a device to measure the main parameters of internal screw thread. Internal thread parameters, such as the pitch diameter, thread angle and screw-pitch of common screw thread, terraced screw thread, zigzag screw thread were obtained through calculation and measurement. The practical applications have proved that this device is convenience to use, and the measurements have a high accuracy. Meanwhile, the application for the patent of invention has been accepted by the Patent Office (Filing number: 200710044081.5).

Preload, Coefficient of Friction, and Thread Friction in an Implant-Abutment-Screw Complex.

PubMed

Wentaschek, Stefan; Tomalla, Sven; Schmidtmann, Irene; Lehmann, Karl Martin

To examine the screw preload, coefficient of friction (COF), and tightening torque needed to overcome the thread friction of an implant-abutment-screw complex. In a customized load frame, 25 new implant-abutment-screw complexes including uncoated titanium alloy screws were torqued and untorqued 10 times each, applying 25 Ncm. Mean preload values decreased significantly from 209.8 N to 129.5 N according to the number of repetitions. The overall COF increased correspondingly. There was no comparable trend for the thread friction component. These results suggest that the application of a used implant-abutment-screw complex may be unfavorable for obtaining optimal screw preload.

The biomechanical consequences of rod reduction on pedicle screws: should it be avoided?

PubMed

Paik, Haines; Kang, Daniel G; Lehman, Ronald A; Gaume, Rachel E; Ambati, Divya V; Dmitriev, Anton E

2013-11-01

Rod contouring is frequently required to allow for appropriate alignment of pedicle screw-rod constructs. When residual mismatch is still present, a rod persuasion device is often used to achieve further rod reduction. Despite its popularity and widespread use, the biomechanical consequences of this technique have not been evaluated. To evaluate the biomechanical fixation strength of pedicle screws after attempted reduction of a rod-pedicle screw mismatch using a rod persuasion device. Fifteen 3-level, human cadaveric thoracic specimens were prepared and scanned for bone mineral density. Osteoporotic (n=6) and normal (n=9) specimens were instrumented with 5.0-mm-diameter pedicle screws; for each pair of comparison level tested, the bilateral screws were equal in length, and the screw length was determined by the thoracic level and size of the vertebra (35 to 45 mm). Titanium 5.5-mm rods were contoured and secured to the pedicle screws at the proximal and distal levels. For the middle segment, the rod on the right side was intentionally contoured to create a 5-mm residual gap between the inner bushing of the pedicle screw and the rod. A rod persuasion device was then used to engage the setscrew. The left side served as a control with perfect screw/rod alignment. After 30 minutes, constructs were disassembled and vertebrae individually potted. The implants were pulled in-line with the screw axis with peak pullout strength (POS) measured in Newton (N). For the proximal and distal segments, pedicle screws on the right side were taken out and reinserted through the same trajectory to simulate screw depth adjustment as an alternative to rod reduction. Pedicle screws reduced to the rod generated a 48% lower mean POS (495±379 N) relative to the controls (954±237 N) (p<.05) and significantly decreased work energy to failure (p<.05). Nearly half (n=7) of the pedicle screws had failed during the reduction attempt with visible pullout of the screw. After reduction, decreased POS was observed in both normal (p<.05) and osteoporotic (p<.05) bone. Back out and reinsertion of the screw resulted in no significant difference in mean POS, stiffness, and work energy to failure (p>.05). In circumstances where a rod is not fully seated within the pedicle screw, the use of a rod persuasion device decreases the overall POS and work energy to failure of the screw or results in outright failure. Further rod contouring or correction of pedicle screw depth of insertion may be warranted to allow for appropriate alignment of the longitudinal rods. Published by Elsevier Inc.

Reverse shoulder arthroplasty glenoid fixation: is there a benefit in using four instead of two screws?

PubMed

James, Jaison; Allison, Mari A; Werner, Frederick W; McBride, Devin E; Basu, Niladri N; Sutton, Levi G; Nanavati, Vipul N

2013-08-01

To allow osseous integration to occur and thus provide long-term stability, initial glenoid baseplate fixation must be sufficiently rigid. A major contributing factor to initial rigid fixation is baseplate screw fixation. Current baseplate designs use a 4-screw fixation construct. However, recent literature suggests adequate fixation can be achieved with fewer than 4 screws. The purpose of the present study was to determine whether a 4-screw construct provides more baseplate stability than a 2-screw construct. A flat-backed glenoid baseplate with 4 screw hole options was implanted into 6 matched pairs of cadaver scapulas using standard surgical technique. Within each pair, 2 screws or 4 screws were implanted in a randomized fashion. A glenosphere was attached allowing cyclic loading in an inferior-to-superior direction and in an anterior-to-posterior direction. Baseplate motion was measured using 4 linear voltage displacement transducers evenly spaced around the glenosphere. There was no statistical difference in the average peak central displacements between fixation with 2 or 4 screws (P = .338). Statistical increases in average peak central displacement with increasing load (P < .001) and with repetitive loading (P < .002) were found. This study demonstrates no statistical difference in baseplate motion between 2-screw and 4-screw constructs. Therefore, using fewer screws could potentially lead to a reduction in operative time, cost, and risk, with no significant negative effect on overall implant baseplate motion. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Twin- or single-screw extrusion of raw soybeans and preconditioned soybean meal and corn as individual ingredients or as corn-soybean product blends in diets for weanling swine.

PubMed

Veum, T L; Serrano, X; Hsieh, F H

2017-03-01

Two 28-d experiments were conducted to evaluate the effects of extrusion of ground yellow corn, solvent-extracted soybean meal (SBM), and cracked whole soybeans (CWS) individually or as corn-soybean product blends on growth performance of weanling pigs. For Exp. 1, ground corn, SBM, and the corn-SBM blend were extruded at 137.5°C, 131.5°C, and 135.0°C, respectively, in a twin-screw extruder. Transit time was 60 s. Water was injected at 125 gmin during extrusion. The 5 treatments were the corn-SBM control diet and the diets with extruded (EX) corn + SBM, EX-SBM + corn, EX-corn + EX-SBM, and the EX-blend of corn-SBM. Ninety crossbred pigs with an initial average BW of 5.98 kg were allotted to 9 treatment replications with a barrow and gilt per pen. For Exp. 2, ground corn was preconditioned with water (10.0% of corn weight), and SBM was preconditioned with water and soybean oil (each at 20.0% of SBM weight) before extrusion. Raw CWS were not preconditioned. The corn, SBM, CWS, corn-SBM blend, and corn-CWS blend were extruded at 113.0°C, 132.0°C, 132.0°C, 88.0°C, and 102°C, respectively, with a single-screw extruder. Transit time was 30 s. The 8 isocaloric treatments were the corn-SBM control diet and the diets with EX-corn + SBM, EX-SBM + corn, EX-corn + EX-SBM, the EX-blend of corn-SBM, EX-CWS + corn, EX-CWS + EX-corn, and the EX-blend of corn-CWS. A total of 296 crossbred pigs with an initial average BW of 6.56 kg were allotted to 10 treatment replications. Sex and pigs per pen (3 or 4) were equalized within replication. Results for both experiments indicate that single- or twin-screw extrusion of ground corn or SBM as individual ingredients or as corn-SBM blends in diets for weanling pigs did not improve 28-d growth performance. However, for Exp. 2 weanling pigs fed the diets with EX-CWS + corn and EX-CWS + EX-corn had greater ( < 0.01) ADG and G:F, respectively, than pigs fed the corn-SBM control diet. The extrusion temperature of 102°C for the corn-CWS blend did not inactivate adequate protease inhibitors in CWS, and pigs fed that diet had poor growth performance. In conclusion, single-screw extrusion of CWS (132°C for 30 s) in diets for weanling pigs improved growth performance compared with pigs fed the corn-SBM control diet. However, twin- or single-screw extrusion of ground yellow corn or solvent-extracted SBM as individual ingredients or as corn-SBM blends in diets for weanling pigs did not improve growth performance compared with pigs fed the corn-SBM control diets.

Removal of a broken trigen intertan intertrochanteric antegrade nail.

PubMed

Zheng, Xuan-Lin; Park, Young-Chang; Kim, Sungmin; An, Haemosu; Yang, Kyu-Hyun

2017-02-01

Implant breakage is a serious complication after cephalomedullary nailing for unstable intertrochanteric fracture. Failure usually occurs at the lag screw hole in the nail body. On the other hand, lag screw failure is extremely rare and occurs around the nail-lag screw junction. We experienced rare mechanical failure of the Intertan nail, which showed breakage at the lag screw hole and failure of the integrated compression screw underneath the main lag screw. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery.

PubMed

Bredow, Jan; Boese, C K; Werner, C M L; Siewe, J; Löhrer, L; Zarghooni, K; Eysel, P; Scheyerer, M J

2016-08-01

Pedicle screw fixation is the standard technique for the stabilization of the spine, a clinically relevant complication of which is screw loosening. This retrospective study investigates whether preoperative CT scanning can offer a predictor of screw loosening. CT-scan attenuation in 365 patients was evaluated to determine the mean bone density of each vertebral body. Screw loosening or dislocation was determined in CT scans postoperatively using the standard radiological criteria. Forty-five of 365 patients (12.3 %; 24 male, 21 female) suffered postoperative screw loosening (62 of 2038 screws) over a mean follow-up time of 50.8 months. Revision surgeries were necessary in 23 patients (6.3 %). The correlation between decreasing mean CT attenuation in Hounsfield Units (HU) and increasing patient age was significant (p < 0.001). Mean bone density was 116.3 (SD 53.5) HU in cases with screw loosening and 132.7 (SD 41.3) HU in cases in which screws remained fixed. The difference was statistically significant (p = 0.003). The determination of bone density with preoperative CT scanning can predict the risk of screw loosening and inform the decision to use cement augmentation to reduce the incidence of screw loosening.

Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation.

PubMed

Beumer, Annechien; Campo, Martin M; Niesing, Ruud; Day, Judd; Kleinrensink, Gert-Jan; Swierstra, Bart A

2005-01-01

We assessed syndesmotic set screw strength and fixation capacity during cyclical testing in a cadaver model simulating protected weight bearing. Sixteen fresh frozen legs with artificial syndesmotic injuries and a syndesmotic set screw made of stainless steel or titanium, inserted through three or four cortices, were axially loaded with 800 N for 225,000 cycles in a materials testing machine. The 225,000 cycles equals the number of paces taken by a person walking in a below knee plaster during 9 weeks. Syndesmotic fixation failure was defined as: bone fracture, screw fatigue failure, screw pullout, and/or excessive syndesmotic widening. None of the 14 out of 16 successfully tested legs or screws failed. No difference was found in fixation of the syndesmosis when stainless steel screws were compared to titanium screws through three or four cortices. Mean lateral displacement found after testing was 1.05 mm (S.D. = 0.42). This increase in tibiofibular width exceeds values described in literature for the intact syndesmosis loaded with body weight. Based on this laboratory study it is concluded that the syndesmotic set screw cannot prevent excessive syndesmotic widening when loaded with a load comparable with body weight. Therefore, we advise that patients with a syndesmotic set screw in situ should not bear weight.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating.

PubMed

Bacchi, Atais; Regalin, Alexandre; Bhering, Claudia Lopes Brilhante; Alessandretti, Rodrigo; Spazzin, Aloisio Oro

2015-10-01

The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at 10(6) cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukey's test (5%). The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws.

Accuracy of pedicle screw insertion in the thoracic and lumbar spine: a comparative study between percutaneous screw insertion and conventional open technique.

PubMed

Ikeuchi, Hiroko; Ikuta, Ko

2016-09-01

In the last decade, posterior instrumented fusion using percutaneous pedicle screws (PPSs) had been growing in popularity, and its safety and good clinical results have been reported. However, there have been few previous reports of the accuracy of PPS placement compared with that of conventional open screw insertion in an institution. This study aimed to evaluate the accuracy of PPS placement compared with that of conventional open technique. One hundred patients were treated with posterior instrumented fusion of the thoracic and lumbar spine from April 2008 to July 2013. Four cases of revised instrumentation surgery were excluded. In this study, the pedicle screws inserted below Th7 were investigated, therefore, a total of 455 screws were enrolled. Two hundred and ninety-three pedicle screws were conventional open-inserted screws (O-group) and 162 screws were PPSs (P-group). We conducted a comparative study about the accuracy of placement between the two groups. Postoperative computed tomography scans were carried out to all patients, and the pedicle screw position was assessed according to a scoring system described by Zdichavsky et al. (Eur J Trauma 30:241-247, 2004; Eur J Trauma 30:234-240, 2004) and a classification described by Wiesner et al. (Spine 24:1599-1603, 1999). Based on Zdichavsky's scoring system, the number of grade Ia screws was 283 (96.6 %) in the O-group and 153 (94.4 %) in the P-group, whereas 5 screws (1.7 %) in the O-group and one screw (0.6 %) in the P-group were grade IIIa/IIIb. Meanwhile, the pedicle wall penetrations based on Wiesner classification were demonstrated in 20 screws (6.8 %) in the O-group, and 12 screws (7.4 %) in the P-group. No neurologic complications were observed and no screws had to be replaced in both groups. The PPSs could be ideally inserted without complications. There were no statistically significant differences about the accuracy between the conventional open insertion and PPS placement.

[The Effect of Intraoperative Screw Monitoring (Root Monitoring) with the INS-1 System (NUVASIVE) on the Radiological Outcome of Dorsal Instrumentation of the Lumbar Spine].

PubMed

Bernhardt, G; Awiszus, F; Meister, U; Heyde, C E; Böhm, H

2016-06-01

Transpedicular screw fixation of spinal segments has been described for a variety of surgical indications and is a key element in spinal surgery. The aim of transpedicular screw fixation is to achieve maximal stability. Screw malposition should be obviated to avoid neurological complications. There are published methods of applying evoked EMG to control screw position in relation to neural structures. These studies demonstrated that an intact bony pedicle wall acts as an electrical isolator between the screw and spinal nerve root. The aim of our study was to evaluate the impact of intraoperative pedicle screw monitoring on screw positioning. We enrolled 22 patients in this prospective randomised study, who underwent spinal instrumentation after being split into two equal groups. In the first group, dorsal instrumentation was supplemented with intraoperative nerve root monitoring using the INS-1-System (NuVasive, San Diego USA). In the second group, screws were inserted without additional pedicle monitoring. All patients underwent monosegmental instrumentation with "free hand implanted" pedicle screws. 44 screws were inserted in each group. The screw position was evaluated postoperatively using CT scans. The position of the screws in relation to the pedicle was measured in three different planes: sagittal, axial and coronal. The accuracy of the screw position was described using the Berlemann classification system. Screw position is classified in three groups: type 1 correct screw position, type 2 encroachment on the inner cortical wall, type 3 pedicle cortical perforation. Screw angulation and secondary operative criteria were also evaluated. The use of neuromonitoring did not influence the distance between the centre of the screws and the pedicle wall. Distances only depended on the implantation side (right and left) and the height of implantation (caudal or cranial screw). Because of the low number of cases, no conclusion could be reached about the influence of root monitoring on the correct positioning of the screws. There was at least a non-significant trend towards more frequent perforation of the pedicle in the monitor group. In the present study, we showed that root monitoring had a significant effect on the scattering of transversal angles. These were increased compared to the control group. Otherwise, the implantation angle was not shown to depend on the use of neuromonitoring. Neuromonitoring did not influence blood loss or operative time. The data did not permit any conclusion as to whether this technique can minimise the frequency of pedicle screw malposition. The four coronal plane distances did not depend on the use of neuromonitoring. The inclination angle was also unaffected by neuromonitoring. The only parameter for which we found any effect was the transverse angle. The mean values were similar in both groups, but the variances were not equal. The effect of monitoring on the only parameter which could not be evaluated by fluoroscopy is thus rather unfavourable. Georg Thieme Verlag KG Stuttgart · New York.

Bioresorbable screws reinforced with phosphate glass fibre: manufacturing and mechanical property characterisation.

PubMed

Felfel, R M; Ahmed, I; Parsons, A J; Rudd, C D

2013-01-01

Use of bioresorbable screws could eliminate disadvantages associated with metals such as removal operations, corrosion, MRI interference and stress shielding. Mechanical properties of bioresorbable polymers alone are insufficient for load bearing applications application as screws. Thus, reinforcement is necessary to try and match or surpass the mechanical properties of cortical bone. Phosphate based glass fibres were used to reinforce polylactic acid (PLA) in order to produce unidirectionally aligned (UD) and unidirectionally plus randomly distributed (UD/RM) composite screws (P40 UD and P40 UD/RM). The maximum flexural and push-out properties for the composite screws (P40 UD and P40 UD/RM) increased by almost 100% in comparison with the PLA screws. While the pull-out strength and stiffness of the headless composite screws were ∼80% (strength) and ∼130% (stiffness) higher than for PLA, those with heads exhibited properties lower than those for PLA alone as a result of failure at the heads. An increase in the maximum shear load and stiffness for the composite screws (∼30% and ∼40%) in comparison to the PLA screws was also seen. Maximum torque for the PLA screws was ∼1000 mN m, while that for the composite screws were slightly lower. The SEM micrographs for P40 UD and P40 UD/RM screws revealed small gaps around the fibres, which were suggested to be due to buckling of the UD fibres during the manufacturing process. Copyright © 2012 Elsevier Ltd. All rights reserved.

A rationale method for evaluating unscrewing torque values of prosthetic screws in dental implants

PubMed Central

SALIBA, Felipe Miguel; CARDOSO, Mayra; TORRES, Marcelo Ferreira; TEIXEIRA, Alexandre Carvalho; LOURENÇO, Eduardo José Veras; TELLES, Daniel de Moraes

2011-01-01

Objectives Previous studies that evaluated the torque needed for removing dental implant screws have not considered the manner of transfer of the occlusal loads in clinical settings. Instead, the torque used for removal was applied directly to the screw, and most of them omitted the possibility that the hexagon could limit the action of the occlusal load in the loosening of the screws. The present study proposes a method for evaluating the screw removal torque in an anti-rotational device independent way, creating an unscrewing load transfer to the entire assembly, not only to the screw. Material and methods Twenty hexagonal abutments without the hexagon in their bases were fixed with a screw to 20 dental implants. They were divided into two groups: Group 1 used titanium screws and Group 2 used titanium screws covered with a solid lubricant. A torque of 32 Ncm was applied to the screw and then a custom-made wrench was used for rotating the abutment counterclockwise, to loosen the screw. A digital torque meter recorded the torque required to loosen the abutment. Results There was a significant difference between the means of Group 1 (38.62±6.43 Ncm) and Group 2 (48.47±5.04 Ncm), with p=0.001. Conclusion This methodology was effective in comparing unscrewing torque values of the implant-abutment junction even with a limited sample size. It confirmed a previously shown significant difference between two types of screws. PMID:21437472

Surgical screw segmentation for mobile C-arm CT devices

NASA Astrophysics Data System (ADS)

Görres, Joseph; Brehler, Michael; Franke, Jochen; Wolf, Ivo; Vetter, Sven Y.; Grützner, Paul A.; Meinzer, Hans-Peter; Nabers, Diana

2014-03-01

Calcaneal fractures are commonly treated by open reduction and internal fixation. An anatomical reconstruction of involved joints is mandatory to prevent cartilage damage and premature arthritis. In order to avoid intraarticular screw placements, the use of mobile C-arm CT devices is required. However, for analyzing the screw placement in detail, a time-consuming human-computer interaction is necessary to navigate through 3D images and therefore to view a single screw in detail. Established interaction procedures of repeatedly positioning and rotating sectional planes are inconvenient and impede the intraoperative assessment of the screw positioning. To simplify the interaction with 3D images, we propose an automatic screw segmentation that allows for an immediate selection of relevant sectional planes. Our algorithm consists of three major steps. At first, cylindrical characteristics are determined from local gradient structures with the help of RANSAC. In a second step, a DBScan clustering algorithm is applied to group similar cylinder characteristics. Each detected cluster represents a screw, whose determined location is then refined by a cylinder-to-image registration in a third step. Our evaluation with 309 screws in 50 images shows robust and precise results. The algorithm detected 98% (303) of the screws correctly. Thirteen clusters led to falsely identified screws. The mean distance error for the screw tip was 0.8 +/- 0.8 mm and for the screw head 1.2 +/- 1 mm. The mean orientation error was 1.4 +/- 1.2 degrees.

[Development of polyaxial locking plate screw system of sacroiliac joint].

PubMed

Fan, Weijie; Xie, Xuesong; Zhou, Shuping; Zhang, Yonghu

2014-09-01

To develop an instrument for sacroiliac joint fixation with less injury and less complications. Firstly, 18 adult pelvic specimens (8 males and 10 females) were used to measure the anatomical data related to the locking plates and locking screws on the sacrum and ilium, and the polyaxial locking plate screw system of the sacroiliac joint was designed according to the anatomic data. This system was made of medical titanium alloy. Then 4 adult male plevic specimens were harvested and the experiment was divided into 3 groups: group A (normal pelvic), group B (the dislocated sacroiliac joint fixed with sacroiliac screws), and group C (the dislocated sacroiliac joint fixed with polyaxial locking plate screw system). The vertical displacement of sacroiliac joint under the condition of 0-700 N vertical load and the horizontal displacement on angle under the condition of 0-12 N·m torsional load were compared among the 3 groups by using the biological material test system. Finally, the simulated application test was performed on 1 adult male cadaveric specimen to observe soft tissue injury and the position of the locking plate and screw by X-ray films. According to the anatomic data of the sacrum and ilium, the polyaxial locking plate screw system of the sacroiliac joint was designed. The biomechanical results showed that the vertical displacement of the sacroiliac joint under the condition of 0-700 N vertical load in group A was significantly bigger than that in group B and group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The horizontal displacement on angle under the condition of 0-12 N·m torsional load in group A was significantly less than that in group B and group C (P < 0.05). The horizontal displacement on angle under the condition of 0-6 N·m torsional load in group B was bigger than that in group C, and the horizontal displacement on angle under the condition of 6-12 N·m torsional load in group B was less than that in group C, but there was no significant difference between group B and group C (P > 0.05). The test of simulating application showed that the specimen suffered less soft tissue injury, and this instrument could be implanted precisely and safely. The polyaxial locking plate screw system of the sacroiliac joint has the advantages of smaller volume and less injury; polyaxial fixation enables flexible adjustment screw direction. The simulated application test shows satisfactory fixing effect.

Tibiotalar joint arthrodesis for the treatment of severe ankle joint degeneration secondary to rheumatoid arthritis.

PubMed

Caron, M; Kron, E; Saltrick, K R

1999-04-01

The technical aspects of fusion of the rheumatoid ankle do not deviate from those in the post-traumatic or osteoarthritic ankle. Screw fixation can usually be achieved, and rarely is fixation failure a problem in rheumatoid ankle arthrodesis. If fixation is difficult because of deformity or bone quality, external fixation or locking intramedullary nails should be used. The placement of cannulated screws and adequacy of screw fixation has not been a problem (Fig. 13). Screw fixation provides compression and prevents rotation. The surgeon, however, needs to be assured that no screws invade the subtalar joint and that all threads are beyond the arthrodesis site. A washer may be necessary for further stability if this screw is not inserted at too great an angle. The authors have found that troughing out of the cortical surface of the tibia with a power bur aids in screw insertion. Not only does the trough act as a countersink, but it also provides a path for screw insertion and prevents palpable screw irritation. Malalignment is unforgiving. The foot must be placed neutral to dorsiflexion and plantarflexion. Equinus positioning places added stress on the tibia and a back-knee gait occurs. Approximately 5 degrees of valgus is recommended, and varus positioning is unforgiving. Internal and external rotation is determined by the position of the contralateral extremity. Nonunion does not seem to be a problem with rigid internal fixation to any greater degree in patients with RA. Despite this, patients may continue to have pain despite solid fusion, which can be caused by incomplete correction of deformity, painful internal fixation, or adjacent joint pathology. Additionally, patients may experience supramalleolar pain above the fusion site consistent with tibial stress fracture, which is more common if the subtalar or midtarsal joint is rigid or if the patient is obese. A rocker sole shoe with impact-absorbing soles used after brief periods of guarded mobilization in a removable walking cast alleviates this stress on the tibia. Neurovascular insult can be avoided with careful dissection direct to bone, incisions placed in nerve-free zones, and avoidance of plunging deep posteriorly-medially and anteriorly when dissecting and resecting surfaces. Arthrodesis of the tibiotalar joint in the patient with RA should be performed to relieve severe pain caused by advanced arthrosis. Achieving a solid arthrodesis does not seem to be a problem and provides the patient with pain relief; however, marked improvement in patient function and level of activity remains limited by the nature of RA and adjacent joint involvement.

[Growth and deformity after in situ fixation of slipped capital femoral epiphysis].

PubMed

Druschel, C; Placzek, R; Funk, J F

2013-08-01

For mild to moderate slipped capital femoral epiphysis (SCFE) in situ fixation is the current treatment standard. However, concerning the implant selection (screw versus k-wires) as well as the prophylactic stabilisation of the non-affected hip, controversies still exist. The aim of this study was to analyse femoral residual growth and femoral deformities after in situ fixation of SCFE either with k-wires or screws. We conducted a retrospective analysis of the radiographs of adolescents treated for SCFE in our department between 01/2003 and 02/2011. To evaluate femoral growth the articulo-trochanteric distance, centro-trochanteric distance, caput-collum-diaphyseal angle, pin-joint ratio and pin-physis ratio were determined. The femoral deformity was assessed by measuring the sphericity of the femoral head. Degenerative changes were evaluated in the final radiographs. Statistical analysis was performed concerning differences between therapeutically and prophylactically treated hips as well as stabilisations with k-wires and screws. A total of 22 patients (female : male = 14 : 8, mean age girls: 11 ± 1 years, boys: 13 ± 2 years) with 26 slipped capital femoral epiphyses was analysed. K-wires were used for fixation in 4 hips each therapeutically and prophylactically, 22 hips with SCFE and 14 non-affected hips were stabilised with screws. Treatment with screws did not lead to significantly earlier physeal closure than k-wire pinning. Regarding the femoral growth parameters a significant decrease in the articulo-trochanteric distance and CCD angle was detectable in all groups. The pin-joint ratio revealed an adequate residual growth in 58 % of the therapeutically and in 72 % of the prophylactically treated hips without significant difference between k-wires and screws. The pin-physis ratio demonstrated similar values. Regarding the femoral deformity the SCFE hips resulted in a significantly reduced sphericity, which remained unchanged during follow-up. The prophylactic stabilisation did not result in any deterioration of sphericity. The results of this study imply that further growth of the proximal femur after insertion of a sliding screw for in situ stabilisation of mild to moderate slipped capital femoral epiphysis does occur. Furthermore, an increase of deformity during follow-up through screw fixation as compared to pinning was not noticed. Hence, the assumption that screw fixation leads to permanent physeal impairment cannot be confirmed. The consideration of these results may be helpful for implant selection as well as indicating prophylactic surgery for non-affected hips. Georg Thieme Verlag KG Stuttgart · New York.

Systematic review of cortical bone trajectory versus pedicle screw techniques for lumbosacral spine fusion.

PubMed

Phan, Kevin; Ramachandran, Vignesh; Tran, Tommy M; Shah, Kevin P; Fadhil, Matthew; Lackey, Alan; Chang, Nicholas; Wu, Ai-Min; Mobbs, Ralph J

2017-12-01

Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws. This study aims to review the available evidence to assess the merits of the CBT approach. Six electronic databases were searched for original published studies which compared CBT with traditional PS and their findings reviewed. Nine comparative studies were identified through a comprehensive literature search. Studies were classified as retrospective cohort, prospective cohort or case control studies with medium quality as assessed by the GRADE criteria. The available literature is not cohesive regarding outcomes and complications of CBT versus PT procedures. Most studies found no difference in operative time, but reported less blood loss during CBT. Radiological outcomes show no difference in slippage at one year although CBT is associated with greater bone-density compared to PT. Results for post-operative pain are inconclusive.

Design of a surgical instrument for removing bone to provide screw access to a spinal fusion cage.

PubMed

Jabbary Aslani, F; Hukins, D W L; Shepherd, D E T; Parry, J J; Fennell, A J; Lambell, S

2012-01-01

A surgical instrument to aid implantation of a range of lumbar spinal fusion cages has been developed. Once the cage is in position, the entrance to screw holes is partially blocked by the edge of the vertebral body. In order to insert fixation screws to secure the cage between the vertebrae, some part of the blocking edge has to be removed. Rongeurs are currently being used, but they can be time consuming and have the disadvantage that they may remove more bone than is necessary and may cause damage to the fusion cage if not used with care. In addition, access around some of the screw holes may be difficult. The aim of this instrument was to overcome these shortcomings. This paper describes the design of a surgical instrument for cutting edges from vertebral bodies. The development and evaluation of concept designs are presented and discussed. Potential risks were considered and modifications were performed on the selected concept. Functional prototypes were manufactured and tested on sheep lumbar vertebrae. The results showed that the newly designed cutting instrument functions as required and removes the required amount of bone from the vertebral body edge.

Instantaneous death due to transorbital reverse penetration of a screw in an accidental fall: unusual autopsy case report and review of the literature.

PubMed

Gioia, Sara; Bacci, Mauro; Lancia, Massimo; Carlini, Luigi; Suadoni, Fabio

2014-03-01

We present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board. A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as "reverse penetration." The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere. These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury. The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit. Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident. To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical. The case is now under discussion, and a review of pertinent literature is performed.

Implant Dentistry: Monitoring of Bacteria Along the Transmucosal Passage of the Healing Screw in Absence of Functional Load

PubMed Central

MEYNARDI, F.; PASQUALINI, M.E.; ROSSI, F.; DAL CARLO, L.; NARDONE, M.; BAGGI, L.

2016-01-01

SUMMARY Purpose To assess the changes in bacterial profile along the transmucosal path of healing screws placed immediately after insertion of two-piece endosseus implants during the 4-month osseointegration phase, in absence of functional load. Materials and methods Two site-specific samples were collected at the peri-implant mucosa of the healing screws of 80 two-piece implants, for a total of 640 samples. Implants placement was performed following a single protocol with flapless technique, in order to limit bacterial contamination of the surgical site. Identical healing screws (5 mm diameter/4 mm height) were used for each of the 80 implants. During the 4 months of the study, the patients followed a standard oral care regimen with no special hygiene maneuvers at the collection sites. Results The present research documents that during the 4-month period prior to application of function load the bacterial profile of all sites exhibited a clear prevalence of cocci at the interface between implant neck and osteoalveolar crest margin. Conclusions A potentially pathogenic bacterial flora developed only along the peri-implant transmucosal path. PMID:28280528

The Corona Dentis: Description of an Anatomic Variant with Technical Implications for Anterior Odontoid Screw Placement.

PubMed

Alonso, Fernando; Iwanaga, Joe; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

2017-08-01

Type 2 odontoid fractures are the most common cervical fractures among the elderly. Neurologic deficit is usually caused by myelopathy as a result of posterior dens migration. Direct anterior screw placement provides stabilization and can preserve C1-C2 movement. The presence of a bony excrescence on the anterior superior tip of the dens may lead to placement of a screw of incorrect length. Twenty C2 dry specimens were examined for the presence of a corona dentis, which is a bony excrescence in the coronal plane near the apex of the dens. When identified, measurements of the corona dentis were performed using calipers and a ruler. In addition, anteroposterior (AP) and lateral fluoroscopy was performed on all specimens found to have a corona dentis. A corona dentis was found on 20% of our C2 specimens and had an average width of 9 mm and an average height of 4.5 mm. The average width of the dens did not vary as the normal tip of the dens transitioned into the coronae. In no specimen did the corona dentis seem to be composed of trabecular bone and it was seen as a superior projection of cortical bone on fluoroscopy. On fluoroscopy, the corona dentis could be identified on a true AP projection. In angulated AP views, fluoroscopic images overestimated the length of the corona dentis. We describe a new entity termed the corona dentis because of its crownlike feature. It is a superior cortical bone protrusion and should be noted as a variant of the dens during anterior odontoid screw placement. Its propensity to increase the height of the dens markedly can lead to higher rates of neurologic deficits during type 2 odontoid fractures if not appreciated. A true AP view is critical for correct screw size placement. Copyright © 2017 Elsevier Inc. All rights reserved.

The measure method of internal screw thread and the measure device design

NASA Astrophysics Data System (ADS)

Hu, Dachao; Chen, Jianguo

2008-12-01

In accordance with the principle of Three-Line, this paper analyzed the correlation of every main parameter of internal screw thread, and then designed a device to measure the main parameters of internal screw thread. Basis on the measured value and corresponding formula calculation, we can get the internal thread parameters, such as the pitch diameter, thread angle and screw-pitch of common screw thread, terraced screw thread, zigzag screw thread and some else. The practical application has proved that this operation of this device is convenience, and the measured dates have a high accuracy. Meanwhile, the application of this device's patent of invention is accepted by the Patent Office. (The filing number: 200710044081.5)

Biomechanical comparison of 3.0 mm headless compression screw and 3.5 mm cortical bone screw in a canine humeral condylar fracture model.

PubMed

Gonsalves, Mishka N; Jankovits, Daniel A; Huber, Michael L; Strom, Adam M; Garcia, Tanya C; Stover, Susan M

2016-09-20

To compare the biomechanical properties of simulated humeral condylar fractures reduced with one of two screw fixation methods: 3.0 mm headless compression screw (HCS) or 3.5 mm cortical bone screw (CBS) placed in lag fashion. Bilateral humeri were collected from nine canine cadavers. Standardized osteotomies were stabilized with 3.0 mm HCS in one limb and 3.5 mm CBS in the contralateral limb. Condylar fragments were loaded to walk, trot, and failure loads while measuring construct properties and condylar fragment motion. The 3.5 mm CBS-stabilized constructs were 36% stiffer than 3.0 mm HCS-stabilized constructs, but differences were not apparent in quality of fracture reduction nor in yield loads, which exceeded expected physiological loads during rehabilitation. Small residual fragment displacements were not different between CBS and HCS screws. Small fragment rotation was not significantly different between screws, but was weakly correlated with moment arm length (R² = 0.25). A CBS screw placed in lag fashion provides stiffer fixation than an HCS screw, although both screws provide similar anatomical reduction and yield strength to condylar fracture fixation in adult canine humeri.

Positive displacement compounding of a heavy duty diesel engine

NASA Technical Reports Server (NTRS)

Sekar, R.; Kamo, R.

1983-01-01

A helical screw type positive displacement (PD) compressor and expander was considered as an alternative to the turbocharger and the power turbine in the Cummins advanced turbocompound engine. The Institute of Gas Technology (IGT) completed the design, layout, and performance prediction of the PD machines. The results indicate that a screw compressor-expander system is feasible up to at least 750 HP, dry operation of the rotors is feasible, cost and producibility are uncertain, and the system will yield about 4% improvement in brake specific fuel consumption (BSFC) over the advanced turbocompound engine.

Risks to the Superior Gluteal Neurovascular Bundle During Iliosacral and Transsacral Screw Fixation: A Computed Tomogram Arteriography Study.

PubMed

Maslow, Jed; Collinge, Cory A

2017-12-01

Iliosacral (IS) and transsacral (TS) screws are popular techniques to repair complicated injuries to the pelvis. The anatomy of the superior gluteal neurovasculature (SG NV bundle) is well described as running along the posterior ilium, providing innervation and perfusion to important abductor muscles. The method of pelvis fixation least likely to injure the SG NV bundle is unknown. Twenty uninjured patients with a contrasted computed tomogram of the pelvis and lower extremities (CTA) were evaluated. Starting points for an S1 IS screw and S1 and S2 TS screws were estimated on the "ghost" lateral CTA image for those pelvi with safe corridors (>9 mm diameter). The distance from the projected screw to the SG artery was measured. A distance of <3.65 mm (half of a 7.3-mm screw's diameter) was considered likely for NV bundle injury. Of 40 pelvi CTAs (single sides), 10 pelvi (25%) were determined to be inappropriate for an S1 TS screw. The average distances from the screw starting point and the artery were 25.3 mm (±9.2) for S1 IS, 12.4 mm (±9.0) for S1 TS, and 23.5 mm (±10.7) for S2 TS screws, respectively. Ten S1 TS screws (25%) and no S1 IS or S2 TS screws were projected to have caused injury to the SG NV bundle (P < 0.001). Inserting S1 IS and S2 TS screws put the SG NV anatomy at significantly less risk than S1 TS screws. This information may aid in choosing the "best" fixation option for patients with pelvic ring trauma requiring surgery.

Plantar-to-dorsal compared to dorsal-to-plantar screw fixation for proximal chevron osteotomy: a biomechanical analysis.

PubMed

Sharma, Krishn M; Parks, Brent G; Nguyen, Augustine; Schon, Lew C

2005-10-01

A change in screw orientation in fixing the chevron proximal first metatarsal osteotomy was noted anecdotally to improve fixation strength. The authors hypothesized that plantar-to-dorsal screw orientation would be more stable than the conventional dorsal-to-plantar screw orientation for fixation of the chevron osteotomy. The purpose of this study was to determine if the load-to-failure and stiffness of the chevron type proximal first metatarsal osteotomy stabilized using plantar-to-dorsal screw fixation were greater than with the more conventional dorsal-to-plantar screw fixation method. One foot from each of eight matched cadaver pairs was randomly assigned to one of two groups: 1) fixation with a dorsal-to-plantar lag screw or 2) fixation with a plantar-to-dorsal lag screw. A proximal chevron osteotomy was then created using standard technique and the metatarsal was fixed according to previously established method. The bone was potted in polyester resin, and the construct was fitted into a materials testing system machine in which load was applied to the plantar aspect of the metatarsal until failure. The two groups were compared using a two-tailed Student t test. The average load-to-failure and stiffness of the chevron osteotomy fixed with the plantar-to-dorsal lag screw were significantly greater (p < 0.05) than the group fixed with more conventional dorsal-to-plantar lag screws. Plantar-to-dorsal screw orientation was more stable than the conventional dorsal-to-plantar screw orientation for fixation of the proximal chevron osteotomy. Plantar-to-dorsal screw orientation should be considered when using the chevron proximal first metatarsal osteotomy.

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

PubMed

Schizas, Constantin; Theumann, Nicolas; Kosmopoulos, Victor

2007-05-01

Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified Roy-Camille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using image-guided navigation at the thoracic level.

Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty.

PubMed

DiStefano, James Guido; Park, Andrew Y; Nguyen, Thuc-Quyen D; Diederichs, Gerd; Buckley, Jenni M; Montgomery, William H

2011-04-01

Scapular cortical thickness has not been fully characterized from the perspective of determining optimal screw placement for securing the glenoid base plate in reverse shoulder arthroplasty. Twelve fresh frozen cadaveric scapulae underwent high resolution CT scans with 3-dimensional reconstructions and wall thickness analysis. Digital base plates were positioned and virtual screws were placed according to 2 scenarios: A - intraosseous through the entire course and exits a "safe region" with no known neurovascular structures; B - may leave and re-enter the bone and penetrates the thickest cortical region accessible regardless of adjacent structures. For scenario A, the optimal screw configurations were: (superior screw) length = 35 mm, 9° superior, 2° posterior; (inferior screw-A) length = 34 mm, 16° inferior, 5° anterior; (inferior screw-B) length = 31 mm, 31 inferior, 4 posterior; (posterior screw) length 19 mm, 29° inferior, 3° anterior. For scenario B: (superior screw) length = 36 mm, 28° superior, 10° anterior; (inferior screw) length = 35 mm, 19° inferior, 4° anterior; (posterior screw) length 37 mm, 23° superior, 3° anterior. The anterior screw was consistent between scenarios A and B, averaged 29 mm in length and was directed 16° inferior and 14° posterior. Thicker cortical regions were present in the lateral aspect of the suprascapular notch, scapular spine base, anterior/superior aspect of inferior pillar and junction of glenoid neck and scapular spine. Regions with high cortical thickness were accessible for both scenarios except for the posterior screw in scenario A. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Locking design affects the jamming of screws in locking plates.

PubMed

Sandriesser, Sabrina; Rupp, Markus; Greinwald, Markus; Heiss, Christian; Augat, Peter; Alt, Volker

2018-06-01

The seizing of locking screws is a frequently encountered clinical problem during implant removal of locking compression plates (LCP) after completion of fracture healing. The aim of this study was to investigate the effect of two different locking mechanisms on the seizing of locking screws. Specifically, the removal torques before and after cyclic dynamic loading were assessed for screws inserted at the manufacturer-recommended torque or at an increased insertion torque. The seizing of 3.5-mm angular stable screws was assessed as a function of insertion torque for two different locking mechanisms (Thread & Conus and Thread Only). Locking screws (n=10 for each configuration) were inserted either according to the manufacturer-recommended torque or at an increased torque of 150% to simulate an over-insertion of the screw. Half of the screws were removed directly after insertion and the remaining half was removed after a dynamic load protocol of 100,000 cycles. The removal torques of locking screws exceeded the insertion torques for all tested conditions confirming the adequacy of the test setup in mimicking screw seizing in locked plating. Screw seizing was more pronounced for Thread Only design (+37%) compared to Thread & Conus design (+14%; P<0.0001). Cyclic loading of the locking construct consistently resulted in an increased seizing of the locking screws (P<0.0001). Clinical observations from patients treated with the Thread & Conus locking design confirm the biomechanical findings of reduction in seizing effect by using a Thread & Conus design. In conclusion, both over-tightening and cyclic loading are potential causes for screw seizing in locking plate implants. Both effects were found to be less pronounced in the Thread & Conus design as compared to the traditional Thread Only design. © 2018 Elsevier Ltd. All rights reserved.

Multidirectional volar fixed-angle plating using cancellous locking screws for distal radius fractures--evaluation of three screw configurations in an extra-articular fracture model.

PubMed

Weninger, Patrick; Dall'Ara, Enrico; Drobetz, Herwig; Nemec, Wolfgang; Figl, Markus; Redl, Heinz; Hertz, Harald; Zysset, Philippe

2011-01-01

Volar fixed-angle plating is a popular treatment for unstable distal radius fractures. Despite the availability of plating systems for treating distal radius fractures, little is known about the mechanical properties of multidirectional fixed-angle plates. The aim of this study was to compare the primary fixation stability of three possible screw configurations in a distal extra-articular fracture model using a multidirectional fixed-angle plate with metaphyseal cancellous screws distally. Eighteen Sawbones radii (Sawbones, Sweden, model# 1027) were used to simulate an extra-articular distal radius fracture according to AO/OTA 23 A3. Plates were fixed to the shaft with one non-locking screw in the oval hole and two locking screws as recommended by the manufacturer. Three groups (n = 6) were defined by screw configuration in the distal metaphyseal fragment: Group 1: distal row of screws only; Group 2: 2 rows of screws, parallel insertion; Group 3: 2 rows of screws, proximal screws inserted with 30° of inclination. Specimens underwent mechanical testing under axial compression within the elastic range and load controlled between 20 N and 200 N at a rate of 40 N/s. Axial stiffness and type of construct failure were recorded. There was no difference regarding axial stiffness between the three groups. In every specimen, failure of the Sawbone-implant-construct occurred as plastic bending of the volar titanium plate when the dorsal wedge was closed. Considering the limitations of the study, the recommendation to use two rows of screws or to place screws in the proximal metaphyseal row with inclination cannot be supported by our mechanical data.

[Augmentation technique on the proximal humerus].

PubMed

Scola, A; Gebhard, F; Röderer, G

2015-09-01

The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test. The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD. The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.

Extraction of Volatiles from Regolith or Soil on Mars, the Moon, and Asteroids

NASA Technical Reports Server (NTRS)

Linne, Diane; Kleinhenz, Julie; Trunek, Andrew; Hoffman, Stephen; Collins, Jacob

2017-01-01

NASA's Advanced Exploration Systems ISRU Technology Project is evaluating concepts to extract water from all resource types Near-term objectives: Produce high-fidelity mass, power, and volume estimates for mining and processing systems Identify critical challenges for development focus Begin demonstration of component and subsystem technologies in relevant environment Several processor types: Closed processors either partially or completely sealed during processing Open air processors operates at Mars ambient conditions In-situ processors Extract product directly without excavation of raw resource Design features Elimination of sweep gas reduces dust particles in water condensate Pressure maintained by height of soil in hopper Model developed to evaluate key design parameters Geometry: conveyor diameter, screw diameter, shaft diameter, flight spacing and pitch Operational: screw speed vs. screw length (residence time) Thermal: Heat flux, heat transfer to soil Testing to demonstrate feasibility and performance Agglomeration, clogging Pressure rise forced flow to condenser.

Helical screw expander evaluation project

NASA Technical Reports Server (NTRS)

Mckay, R.

1982-01-01

A one MW helical rotary screw expander power system for electric power generation from geothermal brine was evaluated. The technology explored in the testing is simple, potentially very efficient, and ideally suited to wellhead installations in moderate to high enthalpy, liquid dominated field. A functional one MW geothermal electric power plant that featured a helical screw expander was produced and then tested with a demonstrated average performance of approximately 45% machine efficiency over a wide range of test conditions in noncondensing, operation on two-phase geothermal fluids. The Project also produced a computer equipped data system, an instrumentation and control van, and a 1000 kW variable load bank, all integrated into a test array designed for operation at a variety of remote test sites. Data are presented for the Utah testing and for the noncondensing phases of the testing in Mexico. Test time logged was 437 hours during the Utah tests and 1101 hours during the Mexico tests.

Nonlinear Friction Compensation of Ball Screw Driven Stage Based on Variable Natural Length Spring Model and Disturbance Observer

NASA Astrophysics Data System (ADS)

Asaumi, Hiroyoshi; Fujimoto, Hiroshi

Ball screw driven stages are used for industrial equipments such as machine tools and semiconductor equipments. Fast and precise positioning is necessary to enhance productivity and microfabrication technology of the system. The rolling friction of the ball screw driven stage deteriorate the positioning performance. Therefore, the control system based on the friction model is necessary. In this paper, we propose variable natural length spring model (VNLS model) as the friction model. VNLS model is simple and easy to implement as friction controller. Next, we propose multi variable natural length spring model (MVNLS model) as the friction model. MVNLS model can represent friction characteristic of the stage precisely. Moreover, the control system based on MVNLS model and disturbance observer is proposed. Finally, the simulation results and experimental results show the advantages of the proposed method.

Biomechanical analysis of occipitocervical stability afforded by three fixation techniques.

PubMed

Helgeson, Melvin D; Lehman, Ronald A; Sasso, Rick C; Dmitriev, Anton E; Mack, Andrew W; Riew, K Daniel

2011-03-01

Occipital condyle screws appear to be a novel technique that demands biomechanical consideration. It has the potential to achieve fixation anterior to the axis of rotation while offering a point of fixation in line with the C1/C2 screws. To compare the segmental stability and range of motion (ROM) of standard occipitocervical (OC) screw/rod and plate constructs versus a new technique that incorporates occipital condyle fixation. Human cadaveric biomechanical analysis. After intact analysis, 10 fresh-frozen human cadaveric OC spine specimens were instrumented bilaterally with C1 lateral mass screws and C2 pedicle screws. Additional occipital instrumentation was tested in random order under the following conditions: standard occipitocervical plate/rod system (Vertex Max; Medtronic, Inc., Minneapolis, MN, USA); occipital condyle screws alone; and occipital condyle screws with the addition of an eyelet screw placed into the occiput bilaterally. After nondestructive ROM testing, specimens were evaluated under computed tomography (CT) and underwent destructive forward flexion failure comparing Group 1 to Group 3. There was no significant difference in OC (Occiput-C1) axial rotation and flexion/extension ROM between the standard occipitocervical plate/rod system (Group 1) and the occipital condyle screws with one eyelet screw bilaterally (Group 3). Furthermore, the occipital condyle screws alone (Group 2) did allow significantly more flexion/extension compared with Group 1. Interestingly, the two groups with occipital condyle screws (Groups 2 and 3) had significantly less lateral bending compared with Group 1. During CT analysis, the mean occipital condyle width was 10.8 mm (range, 9.1-12.7 mm), and the mean condylar length was 24.3 mm (range, 20.2-28.5). On destructive testing, there was no significant difference in forward flexion failure between Groups 1 and 3. With instrumentation across the mobile OC junction, our results indicate that similar stability can be achieved with occipital condyle screws/eyelet screws compared with the standard occipitocervical plate/rod system. Published by Elsevier Inc.

Factors affecting the pullout strength of cancellous bone screws.

PubMed

Chapman, J R; Harrington, R M; Lee, K M; Anderson, P A; Tencer, A F; Kowalski, D

1996-08-01

Screws placed into cancellous bone in orthopedic surgical applications, such as fixation of fractures of the femoral neck or the lumbar spine, can be subjected to high loads. Screw pullout is a possibility, especially if low density osteoporotic bone is encountered. The overall goal of this study was to determine how screw thread geometry, tapping, and cannulation affect the holding power of screws in cancellous bone and determine whether current designs achieve maximum purchase strength. Twelve types of commercially available cannulated and noncannulated cancellous bone screws were tested for pullout strength in rigid unicellular polyurethane foams of apparent densities and shear strengths within the range reported for human cancellous bone. The experimentally derived pullout strength was compared to a predicted shear failure force of the internal threads formed in the polyurethane foam. Screws embedded in porous materials pullout by shearing the internal threads in the porous material. Experimental pullout force was highly correlated to the predicted shear failure force (slope = 1.05, R2 = 0.947) demonstrating that it is controlled by the major diameter of the screw, the length of engagement of the thread, the shear strength of the material into which the screw is embedded, and a thread shape factor (TSF) which accounts for screw thread depth and pitch. The average TSF for cannulated screws was 17 percent lower than that of noncannulated cancellous screws, and the pullout force was correspondingly less. Increasing the TSF, a result of decreasing thread pitch or increasing thread depth, increases screw purchase strength in porous materials. Tapping was found to reduce pullout force by an average of 8 percent compared with nontapped holes (p = 0.0001). Tapping in porous materials decreases screw pullout strength because the removal of material by the tap enlarges hole volume by an average of 27 percent, in effect decreasing the depth and shear area of the internal threads in the porous material.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating

PubMed Central

Regalin, Alexandre; Bhering, Claudia Lopes Brilhante; Alessandretti, Rodrigo; Spazzin, Aloisio Oro

2015-01-01

PURPOSE The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. MATERIALS AND METHODS Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at 106 cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukey's test (5%). RESULTS The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). CONCLUSION The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws. PMID:26576253

PRELOAD AND TORQUE REMOVAL EVALUATION OF THREE DIFFERENT ABUTMENT SCREWS FOR SINGLE STANDING IMPLANT RESTORATIONS

PubMed Central

Stüker, Rafael Augusto; Teixeira, Eduardo Rolim; Beck, João Carlos Pinheiro; da Costa, Nilza Pereira

2008-01-01

Several authors still consider the mechanical problems of fracture and component loosening as the main causes of failure of implant-supported restorations. The purpose of this in vitro study was to compare the preload of three types of screw for transmucosal abutment attachment used in single implant-supported prosthesis through strain gauge and removal torque measurements. Three external hex fixtures were used, and each received a transmucosal abutment (Cera One®), which was fixed to the implant with its respective screw: Group A- gold screw, Group B- titanium screw and Group C- surface-treated titanium screw (Ti-Tite®). Ten screws of each type were attached applying a 30.07±0.28 Ncm torque force and maintained in position for 5 minutes. After this, the preload values were measured using strain gauges and a measurement cell. Gold screws presented higher preload values (131.72±8.98 N), followed by surface-treated titanium screws (97.78±4.68 N) and titanium screws (37.03±5.69 N). ANOVA (p<0.05) and Tukey's test (p<0.05) were applied. Statistically significant differences were found among the groups for both preload and removal torque values. In conclusion, gold screws may be indicated to achieve superior longevity of the abutment-implant connection and, consequently, prosthetic restoration due to greater preload values yielded. PMID:19089290

Biomechanical testing of bioabsorbable cannulated screws for slipped capital femoral epiphysis fixation.

PubMed

Kroeber, Markus W; Rovinsky, David; Haskell, Andrew; Heilmann, Moira; Llotz, Jeff; Otsuka, Norman

2002-06-01

This study compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced poly-levolactic acid to cannulated 4.5-mm steel and titanium screws for resistance to shear stress and ability to generate compression in a polyurethane foam model of slipped capital femoral epiphysis fixation. The maximum shear stress resisted by the three screw types was similar (self-reinforced poly-levolactic acid 371 +/- 146 MPa, steel 442 +/- 43 MPa, and titanium 470 +/- 91 MPa). The maximum compression generated by both the self-reinforced poly-levolactic acid screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3 +/- 1.4 N, P <.05). These data suggest cannulated self-reinforced poly-levolactic acid screws can be used in the treatment of slipped capital femoral epiphysis because of their sufficient biomechanical strength.

Effect of augmentation techniques on the failure of pedicle screws under cranio-caudal cyclic loading.

PubMed

Bostelmann, Richard; Keiler, Alexander; Steiger, Hans Jakob; Scholz, Armin; Cornelius, Jan Frederick; Schmoelz, Werner

2017-01-01

Augmentation of pedicle screws is recommended in selected indications (for instance: osteoporosis). Generally, there are two techniques for pedicle screw augmentation: inserting the screw in the non cured cement and in situ-augmentation with cannulated fenestrated screws, which can be applied percutaneously. Most of the published studies used an axial pull out test for evaluation of the pedicle screw anchorage. However, the loading and the failure mode of pullout tests do not simulate the cranio-caudal in vivo loading and failure mechanism of pedicle screws. The purpose of the present study was to assess the fixation effects of different augmentation techniques (including percutaneous cement application) and to investigate pedicle screw loosening under physiological cyclic cranio-caudal loading. Each of the two test groups consisted of 15 vertebral bodies (L1-L5, three of each level per group). Mean age was 84.3 years (SD 7.8) for group 1 and 77.0 years (SD 7.00) for group 2. Mean bone mineral density was 53.3 mg/cm 3 (SD 14.1) for group 1 and 53.2 mg/cm 3 (SD 4.3) for group 2. 1.5 ml high viscosity PMMA bone cement was used for all augmentation techniques. For test group 1, pedicles on the right side of the vertebrae were instrumented with solid pedicle screws in standard fashion without augmentation and served as control group. Left pedicles were instrumented with cannulated screws (Viper cannulated, DePuy Spine) and augmented. For test group 2 pedicles on the left side of the vertebrae were instrumented with cannulated fenestrated screws and in situ augmented. On the right side solid pedicle screws were augmented with cement first technique. Each screw was subjected to a cranio-caudal cyclic load starting at 20-50 N with increasing upper load magnitude of 0.1 N per cycle (1 Hz) for a maximum of 5000 cycles or until total failure. Stress X-rays were taken after cyclic loading to evaluate screw loosening. Test group 1 showed a significant higher number of load cycles until failure for augmented screws compared to the control (4030 cycles, SD 827.8 vs. 1893.3 cycles, SD 1032.1; p < 0.001). Stress X-rays revealed significant less screw toggling for the augmented screws (5.2°, SD 5.4 vs. 16.1°, SD 5.9; p < 0.001). Test group 2 showed 3653.3 (SD 934) and 3723.3 (SD 560.6) load cycles until failure for in situ and cement first augmentation. Stress X-rays revealed a screw toggling of 5.1 (SD 1.9) and 6.6 (SD 4.6) degrees for in situ and cement first augmentation techniques (p > 0.05). Augmentation of pedicle screws in general significantly increased the number of load cycles and failure load comparing to the nonaugmented control group. For the augmentation technique (cement first, in situ augmented, percutaneously application) no effect could be exhibited on the failure of the pedicle screws. By the cranio-caudal cyclic loading failure of the pedicle screws occurred by screw cut through the superior endplate and the characteristic "windshield-wiper effect", typically observed in clinical practice, could be reproduced.

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation.

PubMed

Di Silvestre, Mario; Bakaloudis, Georgios; Lolli, Francesco; Vommaro, Francesco; Martikos, Konstantinos; Parisini, Patrizio

2008-10-01

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80 degrees traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80 degrees) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80 degrees (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92 degrees vs. PSF-S: 88 degrees), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9 degrees versus -11.3 degrees (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19 degrees vs. -10 degrees; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups.

Magnesium Alloys as a Biomaterial for Degradable Craniofacial Screws

PubMed Central

Henderson, Sarah E.; Verdelis, Konstantinos; Maiti, Spandan; Pal, Siladitya; Chung, William L.; Chou, Da-Tren; Kumta, Prashant N.; Almarza, Alejandro J.

2014-01-01

Recently, magnesium (Mg) alloys have received significant attention as a potential biomaterial for degradable implants, and this study was directed at evaluating the suitability of Mg for craniofacial bone screws. The objective was to implant screws fabricated from commercially available Mg-alloys (pure Mg and AZ31) in-vivo in a rabbit mandible. First, Mg-alloy screws were compared to stainless steel screws in an in-vitro pull-out test and determined to have a similar holding strength (~40N). A finite element model of the screw was created using the pull-out test data, and the model can be used for future Mg-alloy screw design. Then, Mg-alloy screws were implanted for 4, 8, and 12 weeks, with two controls of an osteotomy site (hole) with no implant and a stainless steel screw implanted for 12 weeks. MicroCT (computed tomography) was used to assess bone remodeling and Mg-alloy degradation, both visually and qualitatively through volume fraction measurements for all time points. Histologic analysis was also completed for the Mg-alloys at 12 weeks. The results showed that craniofacial bone remodeling occurred around both Mg-alloy screw types. Pure Mg had a different degradation profile than AZ31, however bone growth occurred around both screw types. The degradation rate of both Mg-alloy screw types in the bone marrow space and the muscle were faster than in the cortical bone space at 12 weeks. Furthermore, it was shown that by alloying Mg, the degradation profile could be changed. These results indicate the promise of using Mg-alloys for craniofacial applications. PMID:24384125

Cervical anterior transpedicular screw fixation (ATPS)—Part II. Accuracy of manual insertion and pull-out strength of ATPS

PubMed Central

Acosta, Frank; Tauber, Mark; Fox, Michael; Martin, Hudelmaier; Forstner, Rosmarie; Augat, Peter; Penzkofer, Rainer; Pirich, Christian; Kässmann, H.; Resch, Herbert; Hitzl, Wolfgang

2008-01-01

Reconstruction after multilevel decompression of the cervical spine, especially in the weakened osteoporotic, neoplastic or infectious spine often requires circumferential stabilization and fusion. To avoid the additional posterior surgery in these cases while increasing rigidity of anterior-only screw-plate constructs, the authors introduce the concept of anterior transpedicular screw (ATPS) fixation. We demonstrated its morphological feasibility as well as its indications in a previous study in Part I of our project. Consequently, the objectives of the current study were to assess the ex vivo accuracy of placing ATPS into the cervical vertebra as well as the biomechanical performance of ATPS in comparison to traditional vertebral body screws (VBS) in terms of pull-out strength (POS). Twenty-three ATPS were inserted alternately to two screws into the pedicles and vertebral bodies, respectively, of six cadaveric specimens from C3–T1. For insertion of ATPS, a manual fluoroscopically assisted technique was used. Pre- and post insertional CT-scans were used to assess accuracy of ATPS insertion in the axial and sagittal planes. A newly designed grading system and accuracy score were used to delineate accuracy of ATPS insertion. Following insertion of screws, 23 ATPS and 22 VBS were subjected to pull-out testing (POT). The bone mineral density (BMD) of each specimen was assessed prior to POT. Statistical analysis showed that the incidence of correctly placed screws and non-critical pedicles breaches in axial plane was 78.3%, and 95.7% in sagittal plane. Hence, according to our definition of “critical” pedicle breach that exposes neurovascular structures at risk, 21.7% (n = 5) of all ATPS inserted showed a critical pedicle breach in axial plane. Notably, no critical pedicle perforation occurred at the C6 to T1 levels. Pull-out testing of ATPS and VBS revealed that pull-out resistance of ATPS was 2.5-fold that of VBS. Mean POS of 23 ATPS with a mean BMD of 0.566 g/cm2 and a mean osseus screw purchase of 27.2 mm was 467.8 N. In comparison, POS of 22 VBS screws with a mean BMD of 0.533 g/cm2 and a mean osseus screw purchase of 16.0 mm was 181.6 N. The difference in ultimate pull-out strength between the ATPS and VBS group was significant (p < 0.000001). Also, accuracy of ATPS placement in axial plane was shown to be significantly correlated with POS. In contrast, there was no correlation between screw-length, BMD, or level of insertion and the POS of ATPS or VBS. The study demonstrated that the use of ATPS might be a new technique worthy of further investigation. The use of ATPS shows the potential to increase construct rigidity in terms of screw-plate pull-out resistance. It might diminish construct failures during anterior-only reconstructions of the highly unstable decompressed cervical spine. Electronic supplementary material The online version of this article (doi:10.1007/s00586-007-0573-x) contains supplementary material, which is available to authorized users. PMID:18224357

A comparison of bicortical and intramedullary screw fixations of Jones' fractures.

PubMed

Husain, Zeeshan S; DeFronzo, Donna J

2002-01-01

Two different fixations for treatment of Jones' fracture were tested in bone models and cadaveric specimens to determine the differences in the stability of the constructs. A bicortical 3.5-mm cannulated cortical screw and an intramedullary 4.0-mm partially threaded cancellous screw were tested using physiologic loads with an Instron 8500 servohydraulic tensiometer (Instron Corporation, Canton, MA). In bone models, the bicortical construct (n = 5, 87+/-23 N) showed superior fixation strength (p = .0009) when compared to the intramedullary screw fixation (n = 5, 25+/-13 N). Cadaveric testing showed similar statistical significance (p = .0124) with the bicortical construct (n = 5, 152+/-71 N) having greater load resistance than the intramedullary screw fixation (n = 4, 29+/-20 N). In bone models, the bicortical constructs (23+/-9 N/mm) showed over twice the elastic modulus than the intramedullary screw fixations (9+/-4 N/mm) with statistical significance (p = .0115). The elastic modulus in the cadaveric group showed a similar pattern between the bicortical (19+/-17 N/mm) and intramedullary (9+/-6 N/mm) screw constructs. Analysis of the bicortical screw failure patterns revealed that screw orientation had a critical impact on fixation stability. The more distal the exit site of the bicortical screw was from the fracture site, the greater the load needed to displace the fixation.

[Tensile strength of bone fixation of hydroxyapatite coated Schanz screws of the Heidelberg External Fixation System (HEFS)--comparative torque measurements in clinical use and in cadaver tibia].

PubMed

Placzek, R; Deuretzbacher, G; Meiss, A L

2002-12-01

It is claimed in the literature that hydroxyapatite(HA)-coated screws of external fixators have superior fixation strength in bone, which is postulated to lead to a substantial decrease in loosening and infection rates. We report on a study of the maximum torque values developed while inserting and removing 30 HA-coated Schanz screws of 8 Heidelberg external fixation systems applied to the tibia to correct leg length differences and axial deformities. The infection rate was determined in accordance with defined criteria, and was found to be about 20% for the HA-coated screws. Screws without infection showed an extraction torque above insertion torque, screws with infection an extraction torque below. A significant correlation (p = 0.05) was seen between infection and decrease in fixation strength (quotient: loosening torque/tightening torque). To exclude the impact of such biological processes as osteointegration and bone remodelling, the clinical results were compared with the torques measured for coated and uncoated Schanz screws in a human cadaveric tibia. A significantly higher fixation strength in bone was found for HA-coated screws in comparison with uncoated screws (p = 0.002). These data warrant a clinical study directly comparing HA-coated and uncoated Schanz screws.

Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques.

PubMed

Elgafy, Hossein; Potluri, Tejaswy; Goel, Vijay K; Foster, Scott; Faizan, Ahmad; Kulkarni, Nikhil

2010-02-15

This is an in vitro biomechanical study. To compare the biomechanical stability of the 3 C1-C2 transarticular screw salvaging fixation techniques. Stabilization of the atlantoaxial complex is a challenging procedure because of its complicated anatomy. Many posterior stabilization techniques of the atlantoaxial complex have been developed with C1-C2 transarticular screw fixation been the current gold standard. The drawback of using the transarticular screws is that it has a potential risk of vertebral artery injury due to a high riding transverse foramen of C2 vertebra, and screw malposition. In such cases, it is not recommended to proceed with inserting the contralateral transarticular screw and the surgeon should find an alternative to fix the contralateral side. Many studies are available comparing different atlantoaxial stabilization techniques, but none of them compared the techniques to fix the contralateral side while using the transarticular screw on one side. The current options are C1 lateral mass screw and short C2 pedicle screw or C1 lateral mass screw and C2 intralaminar screw, or C1-C2 sublaminar wire. Nine fresh human cervical spines with intact ligaments (C0-C4) were subjected to pure moments in the 6 loading directions. The resulting spatial orientations of the vertebrae were recorded using an Optotrak 3-dimensional Motion Measurement System. Measurements were made sequentially for the intact spine after creating type II odontoid fracture and after stabilization with unilateral transarticular screw placement across C1-C2 (TS) supplemented with 1 of the 3 transarticular salvaging techniques on the contralateral side; C1 lateral mass screw and C2 pedicle screw (TS+C1LMS+C2PS), C1 lateral mass and C2 intralaminar screw (TS+C1LMS+C2ILS), or sublaminar wire (TS + wire). The data indicated that all the 3 stabilization techniques significantly decreased motion when compared to intact in all the loading cases (left/right lateral bending, left/right axial rotation, flexion) except extension. All the 3 instrumented specimens were equally stable in extension/flexion and lateral bending modes. TS+C1LMS+C2PS was equivalent to TS+C1LMS+C2ILS (P > 0.05) and superior to TS + wire in axial rotation (P < 0.05). Also, TS+C1LMS+C2ILS was superior to TS + wire in axial rotation (P < 0.05). Fixation of atlantoaxial complex using unilateral transarticular screw supplemented with contralateral C1 lateral mass and C2 intralaminar screws is biomechanically equivalent to C1 lateral mass and C2 pedicle screws and both are biomechanically superior to C1-C2 sublaminar wire in axial rotation.

Bioabsorbable versus metallic interference screws for graft fixation in anterior cruciate ligament reconstruction.

PubMed

Debieux, Pedro; Franciozi, Carlos E S; Lenza, Mário; Tamaoki, Marcel Jun; Magnussen, Robert A; Faloppa, Flávio; Belloti, João Carlos

2016-07-24

Anterior cruciate ligament (ACL) tears are frequently treated with surgical reconstruction with grafts, frequently patella tendon or hamstrings. Interference screws are often used to secure the graft in bone tunnels in the femur and tibia. This review examines whether bioabsorbable interference screws give better results than metal interference screws when used for graft fixation in ACL reconstruction. To assess the effects (benefits and harms) of bioabsorbable versus metallic interference screws for graft fixation in ACL reconstruction. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, trial registers and reference lists of articles. Date of search: January 2016. We included randomised controlled trials and quasi-randomised trials comparing bioabsorbable with metallic interferences screws in ACL reconstruction. The main outcomes sought were subjective-rated knee function, failure of treatment, and activity level. At least two review authors selected eligible trials, independently assessed risk of bias, and cross-checked data. Data were pooled whenever relevant and possible. Requests for further information were sent to the original study authors. We included 12 trials (11 randomised and one quasi-randomised) involving a total of 944 participants, and reporting follow-up results for 774. Participants in the 12 trials underwent ACL reconstruction with either hamstring tendon grafts (five trials) or patellar tendon grafts (seven trials). Trials participants were randomly allocated to bioabsorbable or metallic interference screws for graft fixation in both femur and tibia (seven trials); femur only (three trials); tibia only (one trial); location was not reported in the remaining trial. A variety of materials was used for the bioabsorbable screws, Poly-L-lactic acid (PLLA) being the most common. The metallic screws, where reported, were titanium.All trials were at high risk of bias, which invariably included performance bias. Seven trials were at high risk of attrition bias and eight at high risk of reporting bias. The quasi-randomised trial was assessed as being at high risk for selection bias. Based on these study limitations and insufficiency of the available data, we judged the quality of evidence for all outcomes was very low.The majority of the available data for patient-reported knee function was presented as Lysholm scores (0 to 100; higher scores = better function). There was very low quality but consistent evidence of no clinically important differences between the two groups in Lysholm scores at 12 months follow-up (mean difference (MD) -0.08, 95% confidence interval (CI) -1.48 to 1.32; three trials, 168 participants); 24 months (MD 0.35, 95% CI -1.27 to 1.98; three trials, 113 participants) or five or more years follow-up (MD 1.23, 95% CI -2.00 to 4.47; two trials, 71 participants). This lack of between-group differences was also reported for Lysholm scores in several trials that did not provide sufficient data for pooling as well as for other self-reported knee function scores reported in several trials.Treatment failure was represented by the summed data for implant breakage during surgery and major postoperative complications (implant failure, graft rupture, symptomatic foreign body reactions, effusion and treated arthrofibrosis and related conditions) that were usually described in the trial reports as requiring further substantive treatment. There is very low-quality evidence of greater treatment failure in the bioabsorbable screw group (60/451 versus 29/434; risk ratio (RR) 1.94 favouring metallic screw fixation, 95% CI 1.29 to 2.93; 885 participants, 11 studies). In a population with an assumed risk (based on the median control group risk) of 56 participants per 1000 having treatment failure after metallic screw fixation, this equates to 53 more (95% CI 17 to 108 more) per 1000 participants having treatment failure after bioabsorbable screw fixation. All 16 intraoperative complications in the bioabsorbable screw group were implant breakages upon screw insertion. Treatment failure defined as postoperative complications only still favoured the metallic screw group but the 95% CI also included the potential for a greater risk of treatment failure after metallic screw fixation: 44/451 versus 29/434; RR 1.44, 95% CI 0.93 to 2.23. Based on the assumed risk of 56 participants per 1000 having postoperative treatment failure after metallic screw fixation, this equates to 25 more (95% CI 4 fewer and 69 more) per 1000 participants having this outcome after bioabsorbable screw fixation.There was very low-quality evidence of very similar activity levels in the two groups at 12 and 24 months follow-up measured via the Tegner score (0 to 10; higher scores = greater activity): 12 months (MD 0.08, 95% CI -0.39 to 0.55; 122 participants, two studies); 24 months (MD 0.01, 95% CI -0.54 to 0.57; 72 participants, two studies). There is very low-quality evidence of no difference in self-reported knee function and levels of activity between bioabsorbable and metallic interference screws for graft fixation in ACL reconstruction. There is very low-quality evidence that bioabsorbable screws may be associated with more overall treatment failures, including implant breakage during surgery. Further research does not appear to be a priority, but if undertaken, should also examine costs.

Heat generation during removal of an abutment screw fragment from dental implants.

PubMed

Arias, Sergio R; Rueggeberg, Frederick A; Mettenburg, Donald; Sharawy, Mohamed; Looney, Stephen; Elsayed, Ranya; Elsalanty, Mohammed E

2018-04-01

Little information is available on the effect of drilling speed on surrounding bone during the removal of an abutment screw fragment. The purpose of this in vitro study was to compare, in vitro, the peak temperature increase during the removal of fractured abutment screws from implants placed in a porcine mandible, using drilling speeds of 600 or 2000 rpm. Twenty 4.3×13-mm dental implants were placed in 10 dissected porcine mandibles: 2 implants per mandible, 1 on each side. Localized defects were created in 20 surface-treated abutment screws, which were then tightened into each implant until a reproducible fracture occurred in each screw. The fractured screws were removed with a handpiece removal kit and irrigated with room-temperature water at either 600 or 2000 rpm. The temperature rise at the implant surface was measured at 3 levels with 3 type-K thermocouples. Repeated measure ANOVA was performed with the Tukey-Kramer post hoc test for mean pair-wise comparisons (α=.05 for all tests). Mean peak temperatures were significantly higher at 2000 rpm than at 600 rpm in the mid-body (P<.001) and crestal (P=.003) regions but not in the apical (P=.225) implant locations. No significant differences in mean peak temperatures were found among the 3 locations using 600 rpm (P=.179). In the 2000-rpm group, mean peak temperature in the mid-body area was consistently higher than that in the apical (P<.001) area, and more instances of temperature rise above 56°C and 60°C were observed. In 1 implant from this group, the estimated peak temperature exceeded the bone damage threshold value (50°C for 30 seconds). A drilling speed of 2000 rpm during the removal of abutment screw fragments caused overheating of the outer surface of the implant which may damage the surrounding bone; a speed of 600 rpm appears to be safe. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Finding the right fit: studying the biomechanics of under-tapping with varying thread depths and pitches.

PubMed

Jazini, Ehsan; Petraglia, Carmen; Moldavsky, Mark; Tannous, Oliver; Weir, Tristan; Saifi, Comron; Elkassabany, Omar; Cai, Yiwei; Bucklen, Brandon; O'Brien, Joseph; Ludwig, Steven C

2017-04-01

Compromise of pedicle screw purchase is a concern in maintaining rigid spinal fixation, especially with osteoporosis. Little consistency exists among various tapping techniques. Pedicle screws are often prepared with taps of a smaller diameter, which can further exacerbate inconsistency. The objective of this study was to determine whether a mismatch between tap thread depth (D) and thread pitch (P) and screw D and P affects fixation when under-tapping in osteoporotic bone. This study is a polyurethane foam block biomechanical analysis. A foam block osteoporotic bone model was used to compare pullout strength of pedicle screws with a 5.3 nominal diameter tap of varying D's and P's. Blocks were sorted into seven groups: (1) probe only; (2) 0.5-mm D, 1.5-mm P tap; (3) 0.5-mm D, 2.0-mm P tap; (4) 0.75-mm D, 2.0-mm P tap; (5) 0.75-mm D, 2.5-mm P tap; (6) 0.75-mm D, 3.0-mm P tap; and (7) 1.0-mm D, 2.5-mm P tap. A pedicle screw, 6.5 mm in diameter and 40 mm in length, was inserted to a depth of 40 mm. Axial pullout testing was performed at a rate of 5 mm/min on 10 blocks from each group. No significant difference was noted between groups under axial pullout testing. The mode of failure in the probe-only group was block fracture, occurring in 50% of cases. Among the other six groups, only one screw failed because of block fracture. The other 59 failed because of screw pullout. In an osteoporotic bone model, changing the D or P of the tap has no statistically significant effect on axial pullout. Osteoporotic bone might render tap features marginal. Our findings indicate that changing the characteristics of the tap D and P does not help with pullout strength in an osteoporotic model. The high rate of fracture in the probe-only group might imply the potential benefit of tapping to prevent catastrophic failure of bone. Copyright © 2016 Elsevier Inc. All rights reserved.

Fretting corrosion behavior of nitinol spinal rods in conjunction with titanium pedicle screws.

PubMed

Lukina, Elena; Kollerov, Mikhail; Meswania, Jay; Khon, Alla; Panin, Pavel; Blunn, Gordon W

2017-03-01

Untypical corrosion damage including erosions combined with the build-up of titanium oxide as a corrosion product on the surface of explanted Nitinol spinal rods in the areas where it was in contact with titanium pedicle screw head is reported. It was suggested that Nitinol rods might have inferior fretting corrosion resistance compared with that made of titanium or CoCr. Fretting corrosion of Nitinol spinal rods with titanium (Ti6Al4V) pedicle screws were tested in-vitro by conducting a series of potentiostatic measurements of the peak-to-peak values of fretting corrosion current under bending in a 10% solution of calf serum in PBS. The test included Nitinol rods locked in titanium pedicle screws of different designs. Performance of commercially available titanium (Ti6Al4V) and CoCr spinal rods was also investigated for a comparison. Corrosion damage observed after the in-vitro tests was studied using SEM and EDAX analysis and was compared with patterns on Nitinol rods retrieved 12months after initial surgery. Metal ions level was measured in the test media after in-vitro experiments and in the blood and tissues of the patients who had the rods explanted. The results of this study revealed that Nitinol spinal rods locked in Ti pedicle screws are susceptible to fretting corrosion demonstrating higher fretting corrosion current compared with commercially used Ti6Al4V and CoCr rods. On the surface of Nitinol rods after in-vitro tests and on those retrieved from the patients similar corrosion patterns were observed. Improved resistance to fretting corrosion was observed with Nitinol rods in the in-vitro tests where pedicle screws were used with a stiffer locking mechanism. Since the development of the localized corrosion damage might increase the risk of premature fatigue failure of the rods and result in leaching of Ni ions, it is concluded that Nitinol rods should not be used in conjunction with Ti pedicle screws without special protection especially where the design provides a high degree of mobility to the rods. Copyright © 2016 Elsevier B.V. All rights reserved.

Improved tabletability after a polymorphic transition of delta-mannitol during twin screw granulation.

PubMed

Vanhoorne, V; Bekaert, B; Peeters, E; De Beer, T; Remon, J-P; Vervaet, C

2016-06-15

In most formulations processed via continuous twin screw granulation microcrystalline cellulose (MCC) and/or lactose are used as excipients, but mannitol is also a preferred excipient for wet granulation and tableting due to its non-hygroscopicity and inertness. Therefore, the aim of the current study was to investigate the influence of process parameters on critical quality attributes of granules (moisture content, solid state, morphology, size distribution, specific surface area, friability, flowability and hygroscopicity) and tablets (tensile strength and friability) after twin screw granulation of δ-mannitol. The δ-polymorph was selected since a moisture-induced transformation to β-mannitol was observed during batch wet granulation, which exhibited a unique morphology with a large surface area and improved tabletability. A full factorial experimental design was performed, varying screw speed (400-900rpm), granulation temperature (25-40°C), number of kneading elements (6 or 12) and liquid-to-solid (L/S) ratio, on the granulation unit of a ConsiGma™-25 line (a continuous powder-to-tablet manufacturing system). After tray drying the granules were milled and tableted. The results showed that the polymorphic transition from δ- to β-mannitol also occurred during twin screw granulation, although the residence time and L/S ratios were much lower in continuous twin screw granulation compared to batch processing. However, the polymorphic transition was not complete in all experiments and depended on the L/S ratio, screw speed and number of kneading elements. Nevertheless all granules exhibited the unique morphology linked to the polymorphic transition and had a superior tabletability compared to granules produced with β-mannitol as starting material. This was attributed to enhanced plastic deformation of the granules manufactured using δ-mannitol as starting material. In addition, it was concluded that mannitol was granulated via a different mechanism than other, less-soluble, excipients (e.g. lactose, microcrystalline cellulose) due to its high solubility and dissolution rate as the influence of process parameters on the mannitol granule characteristics was different. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparative effect of implant-abutment connections, abutment angulations, and screw lengths on preloaded abutment screw using three-dimensional finite element analysis: An in vitro study.

PubMed

Kanneganti, Krishna Chaitanya; Vinnakota, Dileep Nag; Pottem, Srinivas Rao; Pulagam, Mahesh

2018-01-01

The purpose of this study is to compare the effect of implant-abutment connections, abutment angulations, and screw lengths on screw loosening (SL) of preloaded abutment using three dimensional (3D) finite element analysis. 3D models of implants (conical connection with hex/trilobed connections), abutments (straight/angulated), abutment screws (short/long), and crown and bone were designed using software Parametric Technology Corporation Creo and assembled to form 8 simulations. After discretization, the contact stresses developed for 150 N vertical and 100 N oblique load applications were analyzed, using ABAQUS. By assessing damage initiation and shortest fatigue load on screw threads, the SL for 2.5, 5, and 10 lakh cyclic loads were estimated, using fe-safe program. The obtained values were compared for influence of connection design, abutment angulation, and screw length. In straight abutment models, conical connection showed more damage (14.3%-72.3%) when compared to trilobe (10.1%-65.73%) at 2.5, 5, and 10 lakh cycles for both vertical and oblique loads, whereas in angulated abutments, trilobe (16.1%-76.9%) demonstrated more damage compared to conical (13.5%-70%). Irrespective of the connection type and abutment angulation, short screws showed more percentage of damage compared to long screws. The present study suggests selecting appropriate implant-abutment connection based on the abutment angulation, as well as preferring long screws with more number of threads for effective preload retention by the screws.

Screw-Retaining Allen Wrench

NASA Technical Reports Server (NTRS)

Granett, D.

1985-01-01

Steadying screws with fingers unnecessary. Crimp in uncompressed spring wire slightly protrudes from one facet of Allen wrench. Compressed spring retains Allen screw. Tool used with Allen-head screws in cramped spaces with little or no room for fingers to hold fastener while turned by wrench.

Self-Inflicted Drywall Screws in the Sagittal Sinus.

PubMed

Guppy, Kern H; Ochi, Calvin

2018-02-01

A 30-year-old right-handed man with a history of schizophrenia presented with 2 self-inflicted drywall screws in the skull. The patient was sleepy but easily arousable; blood tests showed he had taken methamphetamines. Computed tomography and computed tomography angiography of the head showed the frontal screw abutted left of the superior sagittal sinus, and the posterior screw went through the superior sagittal sinus with no extravasation of contrast material at either site. Both screws were removed with exposure of the sagittal sinus using U-shaped craniectomies. There was no bleeding on the removal of the screws. It appears the posterior screw entered between the leaflets of the sagittal sinus dura mater. The patient had returned to work without any sequelae 1 month after injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Quadrupole ion traps and trap arrays: geometry, material, scale, performance.

PubMed

Ouyang, Z; Gao, L; Fico, M; Chappell, W J; Noll, R J; Cooks, R G

2007-01-01

Quadrupole ion traps are reviewed, emphasizing recent developments, especially the investigation of new geometries, guided by multiple particle simulations such as the ITSIM program. These geometries include linear ion traps (LITs) and the simplified rectilinear ion trap (RIT). Various methods of fabrication are described, including the use of rapid prototyping apparatus (RPA), in which 3D objects are generated through point-by-point laser polymerization. Fabrication in silicon using multilayer semi-conductor fabrication techniques has been used to construct arrays of micro-traps. The performance of instruments containing individual traps as well as arrays of traps of various sizes and geometries is reviewed. Two types of array are differentiated. In the first type, trap arrays constitute fully multiplexed mass spectrometers in which multiple samples are examined using multiple sources, analyzers and detectors, to achieve high throughput analysis. In the second, an array of individual traps acts collectively as a composite trap to increase trapping capacity and performance for a single sample. Much progress has been made in building miniaturized mass spectrometers; a specific example is a 10 kg hand-held tandem mass spectrometer based on the RIT mass analyzer. The performance of this instrument in air and water analysis, using membrane sampling, is described.

In vitro validation of a novel mechanical model for testing the anchorage capacity of pedicle screws using physiological load application.

PubMed

Liebsch, Christian; Zimmermann, Julia; Graf, Nicolas; Schilling, Christoph; Wilke, Hans-Joachim; Kienle, Annette

2018-01-01

Biomechanical in vitro tests analysing screw loosening often include high standard deviations caused by high variabilities in bone mineral density and pedicle geometry, whereas standardized mechanical models made of PU foam often do not integrate anatomical or physiological boundary conditions. The purpose of this study was to develop a most realistic mechanical model for the standardized and reproducible testing of pedicle screws regarding the resistance against screw loosening and the holding force as well as to validate this model by in vitro experiments. The novel mechanical testing model represents all anatomical structures of a human vertebra and is consisting of PU foam to simulate cancellous bone, as well as a novel pedicle model made of short carbon fibre filled epoxy. Six monoaxial cannulated pedicle screws (Ø6.5 × 45mm) were tested using the mechanical testing model as well as human vertebra specimens by applying complex physiological cyclic loading (shear, tension, and bending; 5Hz testing frequency; sinusoidal pulsating forces) in a dynamic materials testing machine with stepwise increasing load after each 50.000 cycles (100.0N shear force + 20.0N per step, 51.0N tension force + 10.2N per step, 4.2Nm bending moment + 0.8Nm per step) until screw loosening was detected. The pedicle screw head was fixed on a firmly clamped rod while the load was applied in the vertebral body. For the in vitro experiments, six human lumbar vertebrae (L1-3, BMD 75.4 ± 4.0mg/cc HA, pedicle width 9.8 ± 0.6mm) were tested after implanting pedicle screws under X-ray control. Relative motions of pedicle screw, specimen fixture, and rod fixture were detected using an optical motion tracking system. Translational motions of the mechanical testing model experiments in the point of load introduction (0.9-2.2mm at 240N shear force) were reproducible within the variation range of the in vitro experiments (0.6-3.5mm at 240N shear force). Screw loosening occurred continuously in each case between 140N and 280N, while abrupt failures of the specimen were observed only in vitro. In the mechanical testing model, no translational motion was detected in the screw entry point, while in vitro, translational motions of up to 2.5mm in inferior direction were found, leading to a slight shift of the centre of rotation towards the screw tip. Translational motions of the screw tip of about 5mm in superior direction were observed both in vitro and in the mechanical testing model, while they were continuous in the mechanical testing model and rapidly increasing after screw loosening initiation in vitro. The overall pedicle screw loosening characteristics were qualitatively and quantitatively similar between the mechanical testing model and the human vertebral specimens as long as there was no translation of the screw at the screw entrance point. Therefore, the novel mechanical testing model represents a promising method for the standardized testing of pedicle screws regarding screw loosening for cases where the screw rotates around a point close to the screw entry point. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bacterial adhesion on commercially pure titanium and anatase-coated titanium healing screws: an in vivo human study.

PubMed

Scarano, Antonio; Piattelli, Adriano; Polimeni, Antonella; Di Iorio, Donato; Carinci, Francesco

2010-10-01

Little is known about the mechanisms of bacterial interaction with implant materials in the oral cavity. Other surface characteristics, in addition to surface roughness, seem to be extremely important in relation to plaque formation. Different adhesion affinities of bacteria were reported for different materials. Anatase is a nanoparticle that can be applied to titanium surfaces as a coating. The anatase coating gives special characteristics to the implant surface, including some genetic effects on osteoblasts. In this study, the antibacterial effect of anatase is investigated. The aim of this study is to characterize the percentages of surfaces covered by bacteria on commercially pure (cp) titanium and anatase-coated healing screws. Ten patients participated in this study. The protocol of the study was approved by the ethics committee of the University of Chieti-Pescara. A total of 20 healing screws (10 test and 10 control screws) were used in the study. The control screws were made of cp titanium, whereas the test screws were coated with anatase. Cleaning procedures and agents for chemical plaque control were not applied to the healing screws for the complete duration of the test period. After 7 days, all healing screws were removed, substituted, and processed under scanning electron microscopy for evaluation of the portions of the surfaces covered by bacteria. The supracrestal screw surfaces covered by bacteria on test specimens were not significantly lower than those of control screws (P = 0.174). The subcrestal screw surfaces and threads covered by bacteria on test specimens were significantly lower than those of control screws, and P values were 0.001 and 0.000, respectively. Results show that anatase could be a suitable material for coating implant abutments, with a low colonization potential.

Development of an optically-based tension-indicating implanted orthopedic screw with a luminescent spectral ruler

NASA Astrophysics Data System (ADS)

Ravikumar, Nakul; Rogalski, Melissa M.; Benza, Donny; Lake, Joshua; Urban, Matthew; Pelham, Hunter; Anker, Jeffrey N.; DesJardins, John D.

2017-03-01

An orthopaedic screw was designed with an optical tension-indicator to non-invasively quantify screw tension and monitor the load sharing between the bone and the implant. The screw both applies load to the bone, and measures this load by reporting the strain on the screw. The screw contains a colorimetric optical encoder that converts axial strain into colorimetric changes visible through the head of the screw, or luminescent spectral changes that are detected through tissue. Screws were tested under cyclic mechanical loading to mimic in-vivo conditions to verify the sensitivity, repeatability, and reproducibility of the sensor. In the absence to tissue, color was measured using a digital camera as a function of axial load on a stainless steel cannulated (hollow) orthopedic screw, modified by adding a passive colorimetric strain gauge through the central hole. The sensor was able to quantify clinically-relevant bone healing strains. The sensor exhibited good repeatability and reproducibility but also displayed hysteresis due to the internal mechanics of the screw. The strain indicator was also modified for measurement through tissue by replacing the reflective colorimetric sensor with a low-background X-ray excited optical luminescence signal. Luminescent spectra were acquired through 6 mm of chicken breast tissue. Overall, this research shows feasibility for a unique device which quantifies the strain on an orthopedic screw. Future research will involve reducing hysteresis by changing the mechanism of strain transduction in the screw, miniaturizing the luminescent strain gauge, monitoring bending as well as tension, using alternative luminescent spectral rulers based upon near infrared fluorescence or upconversion luminescence, and application to monitoring changes in pretension and load sharing during bone healing.

Mini-Fragment Fixation Is Equivalent to Bicortical Screw Fixation for Horizontal Medial Malleolus Fractures.

PubMed

Wegner, Adam M; Wolinsky, Philip R; Robbins, Michael A; Garcia, Tanya C; Amanatullah, Derek F

2018-05-01

Horizontal fractures of the medial malleolus occur through application of valgus or abduction force through the ankle that creates a tension failure of the medial malleolus. The authors hypothesize that mini-fragment T-plates may offer improved fixation, but the optimal fixation construct for these fractures remains unclear. Forty synthetic distal tibiae with identical osteotomies were randomized into 4 fixation constructs: (1) two parallel unicortical cancellous screws; (2) two parallel bicortical cortical screws; (3) a contoured mini-fragment T-plate with 2 unicortical screws in the fragment and 2 bicortical screws in the shaft; and (4) a contoured mini-fragment T-plate with 2 bicortical screws in the fragment and 2 unicortical screws in the shaft. Specimens were subjected to offset axial tension loading on a servohydraulic testing system and tracked using high-resolution video. Failure was defined as 2 mm of articular displacement. Analysis of variance followed by a Tukey-Kramer post hoc test was used to assess for differences between groups, with significance defined as P<.05. The mean stiffness (±SD) values of both mini-fragment T-plate constructs (239±83 N/mm and 190±37 N/mm) and the bicortical screw construct (240±17 N/mm) were not statistically different. The mean stiffness values of both mini-fragment T-plate constructs and the bicortical screw construct were higher than that of a parallel unicortical screw construct (102±20 N/mm). Contoured T-plate constructs provide stiffer initial fixation than a unicortical cancellous screw construct. The T-plate is biomechanically equivalent to a bicortical screw construct, but may be superior in capturing small fragments of bone. [Orthopedics. 2018; 41(3):e395-e399.]. Copyright 2018, SLACK Incorporated.

Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction

NASA Astrophysics Data System (ADS)

Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

2014-04-01

Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

Modeling bicortical screws under a cantilever bending load.

PubMed

James, Thomas P; Andrade, Brendan A

2013-12-01

Cyclic loading of surgical plating constructs can precipitate bone screw failure. As the frictional contact between the plate and the bone is lost, cantilever bending loads are transferred from the plate to the head of the screw, which over time causes fatigue fracture from cyclic bending. In this research, analytical models using beam mechanics theory were developed to describe the elastic deflection of a bicortical screw under a statically applied load. Four analytical models were developed to simulate the various restraint conditions applicable to bicortical support of the screw. In three of the models, the cortical bone near the tip of the screw was simulated by classical beam constraints (1) simply supported, (2) cantilever, and (3) split distributed load. In the final analytical model, the cortices were treated as an elastic foundation, whereby the response of the constraint was proportional to screw deflection. To test the predictive ability of the new analytical models, 3.5 mm cortical bone screws were tested in a synthetic bone substitute. A novel instrument was developed to measure the bending deflection of screws under radial loads (225 N, 445 N, and 670 N) applied by a surrogate surgical plate at the head of the screw. Of the four cases considered, the analytical model utilizing an elastic foundation most accurately predicted deflection at the screw head, with an average difference of 19% between the measured and predicted results. Determination of the bending moments from the elastic foundation model revealed that a maximum moment of 2.3 N m occurred near the middle of the cortical wall closest to the plate. The location of the maximum bending moment along the screw axis was consistent with the fracture location commonly observed in clinical practice.

Comparison of the effects of rapid maxillary expansion caused by treatment with either a memory screw or a Hyrax screw on the dentofacial structures--transversal effects.

PubMed

Halıcıoğlu, Koray; Yavuz, Ibrahim

2014-04-01

The aim of the present study was to investigate and compare the effects of conventional Hyrax screw treatment and memory screw treatment on skeletal and dentoalveolar structures. Thirty-two patients with maxillary transversal deficiency were divided into two groups. The memory-screw group included 17 patients (nine females and eight males), while the Hyrax-screw group comprised 15 patients (eight females and seven males). Mean ages of the subjects in the memory-screw and Hyrax-screw groups were 13.00 ± 1.29 and 12.58 ± 1.50 years, respectively. Plaster models and postero-anterior cephalograms were taken from the patients at the beginning of the treatment (T1) and at the end of expansion (T2) and retention periods (T3). The mean expansion period was 7.76 ± 1.04 days in the memory-screw group and 35.46 ± 9.39 days in the Hyrax-screw group. 'Shapiro-Wilk Normality test' was used to determine whether the investigated parameters were homogeneous or not. To determine the treatment changes within the group, 'paired t-test' and 'Wilcoxon signed-ranks test' were applied to the homogeneous and non-homogeneous parameters, respectively. Comparison between the groups was carried out using 'Student's t-test' for homogeneous parameters and 'Mann-Whitney U-test' for the rest. Rapid maxillary expansion was carried out successfully in both the groups. However, the use of memory screw may be advantageous because it shortens the maxillary expansion period, provides additional expansion in the retention period, and generates light forces relative to the conventional Hyrax screw.

Ankle fracture syndesmosis fixation and management: the current practice of orthopedic surgeons.

PubMed

Bava, Eric; Charlton, Timothy; Thordarson, David

2010-05-01

There is a wide variety of treatments for disruption of the syndesmosis. There is also controversy as to which device should be used for fixation of the syndesmosis, how many devices should be used, how many cortices the screws should engage, and whether, when, and where the screws should be removed. We conducted a study to determine how orthopedic surgeons manage these injuries. In a survey, we asked orthopedic trauma and foot and ankle fellowship directors and members of the Orthopaedic Trauma Association and the American Orthopaedic Foot and Ankle Society how they routinely treated the syndesmotic injury component of Danis-Weber type C or Lauge-Hansen pronation-external rotation type IV ankle fractures. The overall response rate was 50% (77/153). Fifty-one percent of respondents routinely used 3.5-mm cortical screws, 24% routinely used 4.5-mm cortical screws, and 14% routinely used a suture fixation device. Forty-four percent of respondents routinely used 1 screw, 44% routinely used 2 screws, and the rest were undecided between 1 and 2 screws. Twenty-nine percent of respondents engaged 3 cortices with syndesmotic screws, and 67% engaged 4 cortices. Syndesmotic screws were routinely removed 65% of the time and left in place 35% of the time. Routine removal of syndesmotic screws was done in the operating room in 95% of cases; it was done at 3 months in 49% of cases, at 4 months in 37%, and at 6 months in 12%. The most common method for treating syndesmotic injuries was through use of 3.5-mm screws engaging 4 cortices routinely removed in the operating room at 3 months. Number of screws used to fix the syndesmosis, either 1 or 2, was evenly split.

Influence of Diamondlike Carbon Coating of Screws on Axial Tightening Force and Stress Distribution on Overdenture Bar Frameworks with Different Fit Levels and Materials.

PubMed

dos Santos, Mateus Bertolini Fernandes; Bacchi, Atais; Consani, Rafael Leonardo Xediek; Correr-Sobrinho, Lourenço

2015-01-01

The aim of this study was to evaluate the axial tightening force applied by conventional and diamondlike carbon (DLC)-coated screws and to verify, through three-dimensional finite element analysis (FEA), the stress distribution caused by different framework materials and prosthetic screws in overdenture frameworks with different misfit levels. The axial tightening force applied by the screw was evaluated by means of a titanium matrix connected to a load cell. Conventional titanium or DLC-coated screws were tightened with a digital torque wrench, and the load values were recorded. The values were applied in an FEA to a bar-clip attachment system connected to two 4.0 × 11-mm external-hexagon titanium implants placed in an anterior edentulous arch. DLC-coated and conventional screws were modeled with their respective axial forces obtained on the experimental evaluation for three bar framework materials (titanium, nickel-chromium, and cobalt-chromium) and three levels of misfit (100, 150, and 200 μm). Von Mises stresses for prosthetic components and maximum principal stress and microstrains (maximum principal strains) for bone tissue were measured. The mean force applied by the conventional screw was 25.55 N (± 1.78); the prosthetic screw coated with a DLC layer applied a mean force of 31.44 N (± 2.11), a statistically significant difference. In the FEA, the DLC screw led to higher stresses on the framework; however, the prosthetic screw suffered lower stress. No influence of screw type was seen in the bone tissue. Titanium frameworks reduced the stress transmitted to the bone tissue and the bar framework but had no influence on the screws. Higher misfit values resulted in an increased stress/strain in bone tissue and bar framework, which was not the case for retention screws.

Effect of screw fixation on acetabular component alignment change in total hip arthroplasty.

PubMed

Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Shibanuma, Nao; Kurosaka, Masahiro

2014-06-01

The use of screws can enhance immediate cup fixation, but the influence of screw insertion on cup position has not previously been measured. The purpose of this study was to quantitatively evaluate the effect of intra-operative screw fixation on acetabular component alignment that has been inserted with the use of a navigation system. We used a navigation system to measure cup alignment at the time of press-fit and after screw fixation in 144 hips undergoing total hip arthroplasty. We also compared those findings with factors measured from postoperative radiographs. The mean intra-operative change of cup position was 1.78° for inclination and 1.81° for anteversion. The intra-operative change of anteversion correlated with the number of screws. The intra-operative change of inclination also correlated with medial hip centre. The insertion of screws can induce changes in cup alignment, especially when multiple screws are used or if a more medial hip centre is required for rigid acetabular fixation.

[Biomechanical properties of bioabsorbable cannulated screws for surgical fixation of dislocated epiphysiolysis capitis femoris].

PubMed

Kröber, M W; Rovinsky, D; Lotz, J; Carstens, C; Otsuka, N Y

2002-06-01

Bioabsorbable materials are well suited for fixation of slipped capital femoral epiphysis (SCFE) as they are resorbable, compatible with magnetic resonance imaging, and well tolerated by the pediatric population. We compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced polylevolactic acid (SR-PLLA) to cannulated 4.5-mm steel and titanium screws for their resistance to shear stress and ability to generate compression in a polyurethane foam model of SCFE fixation. The maximum shear stress resisted by the three screw types was similar (SR-PLLA 371 +/- 146, steel 442 +/- 43, titanium 470 +/- 91 MPa, NS). The maximum compression generated by both the SR-PLLA screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3.0 +/- 1.4 N, p < 0.05). These data suggest that cannulated SR-PLLA screws have sufficient biomechanical strength to be used in the treatment of SCFE.

Characterization of Defects in Scaled Mis Dielectrics with Variable Frequency Charge Pumping

NASA Astrophysics Data System (ADS)

Paulsen, Ronald Eugene

1995-01-01

Historically, the interface trap has been extensively investigated to determine the effects on device performance. Recently, much attention has been paid to trapping in near-interface oxide traps. Performance of high precision analog circuitry is affected by charge trapping in near-interface oxide traps which produces hysteresis, charge redistribution errors, and dielectric relaxation effects. In addition, the performance of low power digital circuitry, with reduced noise margins, may be drastically affected by the threshold voltage shifts associated with charge trapping in near -interface oxide traps. Since near-interface oxide traps may substantially alter the performance of devices, complete characterization of these defects is necessary. In this dissertation a new characterization technique, variable frequency charge pumping, is introduced which allows charge trapped at the interface to be distinguished from the charge trapped within the oxide. The new experimental technique is an extension of the charge pumping technique to low frequencies such that tunneling may occur from interface traps to near-interface oxide traps. A generalized charge pumping model, based on Shockley-Read-Hall statistics and trap-to-trap tunneling theory, has been developed which allows a more complete characterization of near-interface oxide traps. A pair of coupled differential equations governing the rate of change of occupied interface and near-interface oxide traps have been developed. Due to the experimental conditions in the charge pumping technique the equations may be decoupled, leading to an equation governing the rate of change of occupied interface traps and an equation governing the rate of change of occcupied near-interface oxide traps. Solving the interface trap equation and applying non-steady state charge dynamics leads to an interface trap component of the charge pumping current. In addition, solution to the near-interface oxide trap equation leads to an additional oxide trap component to the charge pumping current. Numerical simulations have been performed to support the analytical development of the generalized charge pumping model. By varying the frequency of the applied charge pumping waveform and monitoring the charge recombined per cycle, the contributions from interface traps may be separated from the contributions of the near-interface oxide traps. The generalized charge pumping model allows characterization of the density and spatial distribution of near-interface oxide traps from this variable frequency charge pumping technique. Characterization of interface and near-interface oxide trap generation has been performed on devices exposed to ionizing radiation, hot electron injection, and high -field/Fowler-Nordheim stressing. Finally, using SONOS nonvolatile memory devices, a framework has been established for experimentally determining not only the spatial distribution of near-interface oxide traps, but also the energetic distribution. An experimental approach, based on tri-level charge pumping, is discussed which allows the energetic distribution of near-interface oxide traps to be determined.

Intraoperative computed tomography with an integrated navigation system in stabilization surgery for complex craniovertebral junction malformation.

PubMed

Yu, Xinguang; Li, Lianfeng; Wang, Peng; Yin, Yiheng; Bu, Bo; Zhou, Dingbiao

2014-07-01

This study was designed to report our preliminary experience with stabilization procedures for complex craniovertebral junction malformation (CVJM) using intraoperative computed tomography (iCT) with an integrated neuronavigation system (NNS). To evaluate the workflow, feasibility and clinical outcome of stabilization procedures using iCT image-guided navigation for complex CVJM. The stabilization procedures in CVJM are complex because of the area's intricate geometry and bony structures, its critical relationship to neurovascular structures and the intricate biomechanical issues involved. A sliding gantry 40-slice computed tomography scanner was installed in a preexisting operating room. The images were transferred directly from the scanner to the NNS using an automated registration system. On the basis of the analysis of intraoperative computed tomographic images, 23 cases (11 males, 12 females) with complicated CVJM underwent navigated stabilization procedures to allow more control over screw placement. The age of these patients were 19-52 years (mean: 33.5 y). We performed C1-C2 transarticular screw fixation in 6 patients to produce atlantoaxial arthrodesis with better reliability. Because of a high-riding transverse foramen on at least 1 side of the C2 vertebra and an anomalous vertebral artery position, 7 patients underwent C1 lateral mass and C2 pedicle screw fixation. Ten additional patients were treated with individualized occipitocervical fixation surgery from the hypoplasia of C1 or constraints due to C2 bone structure. In total, 108 screws were inserted into 23 patients using navigational assistance. The screws comprised 20 C1 lateral mass screws, 26 C2, 14 C3, or 4 C4 pedicle screws, 32 occipital screws, and 12 C1-C2 transarticular screws. There were no vascular or neural complications except for pedicle perforations that were detected in 2 (1.9%) patients and were corrected intraoperatively without any persistent nerves or vessel damage. The overall accuracy of the image guidance system was 98.1%. The duration of interruption during the surgical process for the iCT was 8±1.5 minutes. All patients were clinically evaluated using Nurick grade criteria and for neurological deficits 3 months after surgery. Twenty-one patients (91.3%) improved by at least 1 Nurick grade, whereas the grade remained unchanged in 2 (8.7%) patients. Craniovertebral stability and solid bone fusion was achieved in all patients. NNS was found to correlate well with the intraoperative findings, and the recalibration was uneventful in all cases and had an accuracy of 1.8 mm (range, 0.6-2.2 mm). iCT scanning with integrated NNS was found to be both feasible and beneficial in the stabilization procedures for complex CVJM. In this unusual patient population, the technique seemed to be of value for negotiating complex anatomy and for achieving more control over screw placement.

Versatile Clinical Application of the Spike Screw: Direct Anchorage Versus Indirect Anchorage.

PubMed

Kim, Kyung A; Chen, Yu; Kwon, Soon-Yong; Seo, Kyung Won; Park, Ki-Ho; Kim, Seong-Hun

2015-10-01

This article represents clinical application of spike screw, novel design of miniscrew, for direct anchorage and indirect anchorage in orthodontic treatment. Accompanied by easy placement and removal, the spike screw provides good stability for the orthodontic anchorage. The spike screw consists of 6 spikes attached to a washer with laser welded stainless-steel hook that is placed by self-drilling fixation miniscrew. The spike screws were applied to correct malocclusions in patients as follows: traction of impacted canines and protraction of posterior teeth as a direct anchorage and correction of midline discrepancy as an indirect anchorage. For orthodontic traction of impacted canines, spike screws were placed in the mandibular labial mucosal area to create extrusive forces. Afterward, it was utilized for the protraction of posterior teeth. In the second case of the indirect anchorage, spike screw was applied on the midpalatal area to correct midline discrepancy that occurred during orthodontic treatment. The extended hook of a washer was prebended along the curvature of the palate and then secured with a mini screw. The extended hook was bonded to maxillary left first molar. In the first case, the spike screw provided adequate anchorage for the vertical traction of horizontally impacted canine. Since the spike screws were placed in the mandibular anterior lesion, the vertical traction force was applied simply with orthodontic elastics. Also, enough distance was achieved for up-down elastics to work by placing the spike screw in the opposite arch. The force of vertical traction was adjusted with selection of size and force of up-down elastics. Later, it was used to provide anchorage for protraction of mandibular molars without changing orientation of the spike screws. In the second case, the spike screw placed in the midpalatal area was attached to the left first molar and worked as an indirect anchorage. The midline discrepancy was resolved by consolidating the spaces to the left with securing the left first molar location. The novel design of the spike screw permits clinicians to have minimum invasive and easy placement and removal of the appliance while maintaining a good control over tooth movement with improved stability in various clinical cases.

Accuracy of S2 Alar-Iliac Screw Placement Under Robotic Guidance.

PubMed

Laratta, Joseph L; Shillingford, Jamal N; Lombardi, Joseph M; Alrabaa, Rami G; Benkli, Barlas; Fischer, Charla; Lenke, Lawrence G; Lehman, Ronald A

Case series. To determine the safety and feasibility of S2 alar-iliac (S2AI) screw placement under robotic guidance. Similar to standard iliac fixation, S2AI screws aid in achieving fixation across the sacropelvic junction and decreasing S1 screw strain. Fortunately, the S2AI technique minimizes prominent instrumentation and the need for offset connectors to the fusion construct. Herein, we present an analysis of the largest series of robotic-guided S2AI screws in the literature without any significant author conflicts of interest with the robotics industry. Twenty-three consecutive patients who underwent spinopelvic fixation with 46 S2AI screws under robotic guidance were analyzed from 2015 to 2016. Screws were placed by two senior spine surgeons, along with various fellow or resident surgical assistants, using a proprietary robotic guidance system (Renaissance; Mazor Robotics Ltd., Caesara, Israel). Screw position and accuracy was assessed on intraoperative CT O-arm scans and analyzed using three-dimensional interactive viewing and manipulation of the images. The average caudal angle in the sagittal plane was 31.0° ± 10.0°. The average horizontal angle in the axial plane using the posterior superior iliac spine as a reference was 42.8° ± 6.6°. The average S1 screw to S2AI screw angle was 11.3° ± 9.9°. Two violations of the iliac cortex were noted, with an average breach distance of 7.9 ± 4.8 mm. One breach was posterior (2.2%) and one was anterior (2.2%). The overall robotic S2AI screw accuracy rate was 95.7%. There were no intraoperative neurologic, vascular, or visceral complications related to the placement of the S2AI screws. Spinopelvic fixation achieved using a bone-mounted miniature robotic-guided S2AI screw insertion technique is safe and reliable. Despite two breaches, no complications related to the placement of the S2AI screws occurred in this series. Level IV, therapeutic. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study.

PubMed

Charles, Y P; Pelletier, H; Hydier, P; Schuller, S; Garnon, J; Sauleau, E A; Steib, J-P; Clavert, P

2015-05-01

Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern. Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings. Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout. The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty prefilling method was linked to the cement distribution. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine

PubMed Central

Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

2017-01-01

Purpose Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Methods Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. Results A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. Conclusion The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery. PMID:28152039

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

PubMed

Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

2017-01-01

Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

Predicting cancellous bone failure during screw insertion.

PubMed

Reynolds, Karen J; Cleek, Tammy M; Mohtar, Aaron A; Hearn, Trevor C

2013-04-05

Internal fixation of fractures often requires the tightening of bone screws to stabilise fragments. Inadequate application of torque can leave the fracture unstable, while over-tightening results in the stripping of the thread and loss of fixation. The optimal amount of screw torque is specific to each application and in practice is difficult to attain due to the wide variability in bone properties including bone density. The aim of the research presented in this paper is to investigate the relationships between motor torque and screw compression during powered screw insertion, and to evaluate whether the torque during insertion can be used to predict the ultimate failure torque of the bone. A custom test rig was designed and built for bone screw experiments. By inserting cancellous bone screws into synthetic, ovine and human bone specimens, it was established that variations related to bone density could be automatically detected through the effects of the bone on the rotational characteristics of the screw. The torque measured during screw insertion was found to be directly related to bone density and can be used, on its own, as a good predictor of ultimate failure torque of the bone. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

The effect of screw tunnels on the biomechanical stability of vertebral body after pedicle screws removal: a finite element analysis.

PubMed

Liu, Jia-Ming; Zhang, Yu; Zhou, Yang; Chen, Xuan-Yin; Huang, Shan-Hu; Hua, Zi-Kai; Liu, Zhi-Li

2017-06-01

Posterior reduction and pedicle screw fixation is a widely used procedure for thoracic and lumbar vertebrae fractures. Usually, the pedicle screws would be removed after the fracture healing and screw tunnels would be left. The aim of this study is to evaluate the effect of screw tunnels on the biomechanical stability of the lumbar vertebral body after pedicle screws removal by finite element analysis (FEA). First, the CT values of the screw tunnels wall in the fractured vertebral bodies were measured in patients whose pedicle screws were removed, and they were then compared with the values of vertebral cortical bone. Second, an adult patient was included and the CT images of the lumbar spine were harvested. Three dimensional finite element models of the L1 vertebra with unilateral or bilateral screw tunnels were created based on the CT images. Different compressive loads were vertically acted on the models. The maximum loads which the models sustained and the distribution of the force in the different parts of the models were recorded and compared with each other. The CT values of the tunnels wall and vertebral cortical bone were 387.126±62.342 and 399.204±53.612, which were not statistically different (P=0.149). The models of three dimensional tetrahedral mesh finite element of normal lumbar 1 vertebra were established with good geometric similarity and realistic appearance. After given the compressive loads, the cortical bone was the first one to reach its ultimate stress. The maximum loads which the bilateral screw tunnels model, unilateral screw tunnel model, and normal vertebral model can sustain were 3.97 Mpa, 3.83 Mpa, and 3.78 Mpa, respectively. For the diameter of the screw tunnels, the model with a diameter of 6.5 mm could sustain the largest load. In addition, the stress distributing on the outside of the cortical bone gradually decreased as the thickness of the tunnel wall increased. Based on the FEA, pedicle screw tunnels would not decrease the biomechanical stability and strength of the vertebral body. A large diameter of screw tunnel and thick tunnel wall were helpful for the biomechanical stability of the vertebral body.

Total knee replacement-cementless tibial fixation with screws: 10-year results.

PubMed

Ersan, Önder; Öztürk, Alper; Çatma, Mehmet Faruk; Ünlü, Serhan; Akdoğan, Mutlu; Ateş, Yalım

2017-12-01

The aim of this study was to evaluate the long term clinical and radiological results of cementless total knee replacement. A total of 51 knees of 49 patients (33 female and 16 male; mean age: 61.6 years (range, 29-66 years)) who underwent TKR surgery with a posterior stabilized hydroxyapatite coated knee implant were included in this study. All of the tibial components were fixed with screws. The HSS scores were examined preoperatively and at the final follow-up. Radiological assessment was performed with Knee Society evaluating and scoring system. Kaplan-Meier survival analysis was performed to rule out the survival of the tibial component. The mean HSS scores were 45.8 (range 38-60) and 88.1 (range 61-93), preoperatively and at the final follow-up respectively. Complete radiological assessment was performed for 48 knees. Lucent lines at the tibial component were observed in 4 patients; one of these patients underwent a revision surgery due to the loosening of the tibial component. The 10-year survival rate of a tibial component was 98%. Cementless total knee replacement has satisfactory long term clinical results. Primary fixation of the tibial component with screws provides adequate stability even in elderly patients with good bone quality. Level IV, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The Evolution of Naval Warfare Technology and the Impact of Space Systems

DTIC Science & Technology

1987-09-01

water movement since antiquity, the Archimedan screw , powered the first screw steamer, the Archimedes in 1838. The propelling screw solved two of the...cranks connected to horizontal and vertical screws , Bushnell’s Turtle was operated by one man. To find direction and depth the operator used a...containing 150 pounds of powder. The explosive was to be attached to an enemy hull using a separate screw device. In several attempts the little

Does addition of crosslink to pedicle-screw-based instrumentation impact the development of the spinal canal in children younger than 5 years of age?

PubMed

Chen, Zhong-hui; Chen, Xi; Zhu, Ze-zhang; Wang, Bin; Qian, Bang-ping; Zhu, Feng; Sun, Xu; Qiu, Yong

2015-07-01

Use of pedicle screws has been popularized in the treatment of pediatric spinal deformity. Despite many studies regarding the effect of pedicle screws on the immature spine, there is no study concerning the impact of addition of crosslink to pedicle-screw-based instrumentation on the development of the spinal canal in young children. This study aims to determine the influence of the screw-rod-crosslink complex on the development of the spinal canal. This study reviewed 34 patients with congenital scoliosis (14 boys and 20 girls) who were treated with posterior-only hemivertebrectomy and pedicle-screw-based short-segment instrumentation before the age of 5 years. The mean age at surgery in this cohort was 37 ± 11 months (range 21-57 months). They were followed up for at least 24 months. Of these patients, 10 underwent only pedicle screw instrumentation without crosslink, and 24 with additional crosslink placement. The vertebrae were divided into three regions as follows: (1) S-CL (screw-crosslink) region, in which the vertebrae were inserted with bilateral pedicle screws and two rods connected with the crosslink; (2) S (screw) region, in which the vertebrae were inserted with bilateral pedicle screws but without crosslink; (3) NS (no screws) region, which comprised vertebrae cephalad or caudal to the instrumented region. The area, anteroposterior and transverse diameters of the spinal canal were measured at all vertebrae on the postoperative and last follow-up computed tomography axial images. The instrumentation-related parameters were also measured, including the distance between the bilateral screws and the screw base angles. The changes in the above measurements were compared between each region to evaluate the instrumentation's effect on the spinal canal growth. The mean follow-up was 37 ± 13 months (range 24-68 months) and the mean age at the last follow-up was 74 ± 20 months (range 46-119 months). In each region, the spinal canal dimensions significantly increased during the follow-up period. There was no significant difference in the spinal canal growth rate between the S and NS regions or between the S-CL and NS regions. Besides, a comparison of the S-CL and S regions regarding the changes in the measurements of the instrumentation construct revealed no significant differences. Pedicle-screw-based instrumentation does not cause retardation of the development of the spinal canal in young children. Moreover, use of the crosslink added to the screw-rod instrumentation also demonstrates no negative effect on the growth of the spinal canal. Thus, the addition of the crosslink to short screw-based instrumentation is recommended as an alternative to increase fixation stability in growing patients, even in very young pediatric population.

Evaluation of trapping-web designs

USGS Publications Warehouse

Lukacs, P.M.; Anderson, D.R.; Burnham, K.P.

2005-01-01

The trapping web is a method for estimating the density and abundance of animal populations. A Monte Carlo simulation study is performed to explore performance of the trapping web for estimating animal density under a variety of web designs and animal behaviours. The trapping performs well when animals have home ranges, even if the home ranges are large relative to trap spacing. Webs should contain at least 90 traps. Trapping should continue for 5-7 occasions. Movement rates have little impact on density estimates when animals are confined to home ranges. Estimation is poor when animals do not have home ranges and movement rates are rapid. The trapping web is useful for estimating the density of animals that are hard to detect and occur at potentially low densities. ?? CSIRO 2005.

Safe insertion of S-2 alar iliac screws: radiological comparison between 2 insertion points using computed tomography and 3D analysis software.

PubMed

Yamada, Kentaro; Abe, Yuichiro; Satoh, Shigenobu

2018-05-01

OBJECTIVE S-2 alar iliac (S2AI) screws are commonly used as anchors for lumbosacral fixation. A serious potential complication of screw insertion is major vascular injury due to anterior or caudal screw deviation. To avoid screw deviation, the pelvic inlet view on intraoperative fluoroscopy images is recommended. However, there has been no detailed investigation of optimal fluoroscopic incline with the pelvic inlet view. The purpose of this study was to investigate the safety margins and to optimize fluoroscopic settings to avoid screw deviation with 2 reported insertion techniques using 3D analysis software and CT. METHODS The study included 50 patients (25 men and 25 women) who underwent abdominal-pelvic CT. With the use of software, the ideal S2AI screws were set from 2 entry points: A) the midpoint between the S-1 dorsal foramen and the S-2 dorsal foramen where they meet the lateral sacral crest, and B) 1 mm inferior and 1 mm lateral to the S-1 dorsal foramen. Anteriorly or caudally deviated screws were defined as deviation of a half thread of the ideal screw by rotation anteriorly or caudally from the entry point. The angular safety margins were compared between the 2 entry points, and patients with small safety margins were investigated. Subsequently, fluoroscopic images were virtualized on ray sum-rendered images. Conditions that provided proper recognition of screw deviation were investigated via lateral and anteroposterior views with the beam tilted caudally. RESULTS The safety margins of S2AI screws were smaller in the anterior direction than in the caudal direction and by entry point A than by entry point B (A: 9.1° ± 1.6° and B: 9.7° ± 1.5° in the anterior direction; A: 10.9° ± 3.8° and B: 13.9° ± 4.1° in the caudal direction). In contrast, patients with a deep-seated L-5 vertebral body tended to have smaller safety margins in the caudal direction. All anteriorly deviated screws were recognized with a 60°-70° inlet view from the S-1 slope. The caudally deviated screws were all recognized on the lateral view, but 31% of screws at entry point A and 21% of screws at entry point B were not recognized on the pelvic inlet view. CONCLUSIONS S2AI screws should be carefully placed to avoid anterior deviation compared with caudal deviation in terms of the safety margin, except in patients with a deep-seated L-5. The difference in safety margins between entry points A and B was negligible. Intraoperative fluoroscopy is recommended with a pelvic inlet view tilted 60°-70° from the S-1 slope to avoid anterior screw deviation. The lateral view is recommended to confirm that the screw is not deviated caudally.

Development of a high speed extrusion concept using a floating screw sleeve for solid-melt-separation

NASA Astrophysics Data System (ADS)

Karrenberg, Gregor; Wortberg, Johannes

2015-05-01

The High-Speed-S-Truder with floating screw sleeve is an alternative extrusion concept with solid-melt-separation. A fairly conventional 35 mm screw with a length of 21 D, which is accelerated by a 75 kW gearless, water cooled synchronous drive, conveys the resin into a 60 mm screw sleeve with a length of 10 D. Inside the sleeve the material is plasticizied and discharged into the outer screw channel of the sleeve through radial bores. Only the solid bed remains inside. The development of a melt pool - and thus a decrease of the plasticizing capacity - is avoided. The sleeve is rotated by drag forces only (approximately 10 - 15 % of the screw speed). Due to the low speed of the screw sleeve molten material is conveyed to a 4 D Dynamic Mixing Ring in a gentle manner. The DMRs floating ring and the screw sleeve are directly coupled. The granules in the screw channel are stopped by a barrier on the screw in front of the mixing device. So nearly no unmelted material can pass the system. For temperature management in the plastification and mixing zone a 3-zone heating/air-cooling system is used. Various kinds of experiments with the High-Speed S-Truder were conducted. Reachable throughputs with different types of material (LDPE, LLDPE, PP, PS) have been tested. Also three screw geometries, which are mainly varying in the channel depth, were compared. Experimental results and theoretical background will be described in this paper.

Effect of Cortical Screw Diameter on Reduction and Stabilization of Type III Distal Phalanx Fractures: An Equine Cadaveric Study.

PubMed

Kay, Alastair T; Durgam, Sushmitha; Stewart, Matthew; Joslyn, Stephen; Schaeffer, David J; Horn, Gavin; Kesler, Richard; Chew, Peter

2016-11-01

To compare reduction of type III distal phalangeal fractures using 4.5 and 5.5 mm cortical screws placed in lag fashion and an intact hoof capsule model. Cadaveric experimental study. Hooves from 12 adult horses (n=24). Sagittal fractures were created in pairs of distal phalanges after distal interphalangeal joint disarticulation and were reduced with either 4.5 or 5.5 mm cortical screws placed in lag fashion. Contralateral phalanges served as non-reduced controls. Fracture reduction following screw placement was assessed by comparing pre-reduction and post-reduction fracture gap measurements from radiographs using paired t-tests. Effects of incremental loading (0, 135, 270, 540, 800, 1070, and 1335 kg) on fracture gaps in 6 phalanges reduced with 4.5 mm screws and 5 phalanges reduced with 5.5 mm screws were measured from fluoroscopic images and assessed by 2-way ANOVA. Significance was set at P<.05. Type III distal phalanx fractures were reliably created. Only 5.5 mm cortical screws, not 4.5 mm screws, significantly reduced fracture gaps and constrained fracture gap expansion 3 cm distal to the articular surface. Compressive loading closed the fracture gaps at the articular surface in both non-reduced control groups and those reduced with either 5.5 or 4.5 mm screws. The 5.5 mm cortical screws were more effective than 4.5 mm screws in reducing type III distal phalanx fractures and restricting distal fracture gap expansion under load. © Copyright 2016 by The American College of Veterinary Surgeons.

The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws.

PubMed

Chiu, C K; Kwan, M K; Chan, C Y W; Schaefer, C; Hansen-Algenstaedt, N

2015-08-01

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location. ©2015 The British Editorial Society of Bone & Joint Surgery.

In vitro biomechanical comparison of pedicle screws, sublaminar hooks, and sublaminar cables.

PubMed

Hitchon, Patrick W; Brenton, Matthew D; Black, Andrew G; From, Aaron; Harrod, Jeremy S; Barry, Christopher; Serhan, Hassan; Torner, James C

2003-07-01

Three types of posterior thoracolumbar implants are in use today: pedicle screws, sublaminar titaniumcables, and sublaminar hooks. The authors conducted a biomechanical comparison of these three implants in human cadaveric spines. Spine specimens (T5-12) were harvested, radiographically assessed for fractures or metastases, and their bone mineral density (BMD) was measured. Individual vertebrae were disarticulated and fitted with either pedicle screws, sublaminar cables, or bilateral claw hooks. The longitudinal component of each construct consisted of bilateral 10-cm rods connected with two cross-connectors. The vertebral body was embedded in cement, and the rods were affixed to a ball-and-socket apparatus for the application of a distraction force. The authors analyzed 1) 20 vertebrae implanted with screws; 2) 20 with hooks, and 3) 20 with cables. The maximum pullout (MPO) forces prior to failure (mean +/- standard deviation) for the screw, hook, and cable implants were 972 +/- 330, 802 +/- 356, and 654 +/- 248 N, respectively (p = 0.0375). Cables allowed significantly greater displacement (6.80 +/- 3.95 mm) prior to reaching the MPO force than hooks (3.73 +/- 1.42 mm) and screws (4.42 +/- 2.15 mm [p = 0.0108]). Eleven screw-implanted vertebrae failed because of screw pullout. All hook-and-cable-implanted vertebrae failed because of pedicle, middle column, or laminar fracture. These findings suggest that screws possess the greatest pullout strength of the three fixation systems. Sublaminar cables are the least rigid of the three. When screw failure occurred, the mechanism was generally screw back-out, without vertebral fractures.

Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration.

PubMed

Carrera, Ion; Gelber, Pablo Eduardo; Chary, Gaetan; González-Ballester, Miguel A; Monllau, Juan Carlos; Noailly, Jerome

2016-10-01

To assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP). A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated. While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins. Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero.

Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents.

PubMed

Parikh, Shital N; Myer, David; Eismann, Emily A

2014-01-01

Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.

Initial leakage current paths in the vertical-type GaN-on-GaN Schottky barrier diodes

NASA Astrophysics Data System (ADS)

Sang, Liwen; Ren, Bing; Sumiya, Masatomo; Liao, Meiyong; Koide, Yasuo; Tanaka, Atsushi; Cho, Yujin; Harada, Yoshitomo; Nabatame, Toshihide; Sekiguchi, Takashi; Usami, Shigeyoshi; Honda, Yoshio; Amano, Hiroshi

2017-09-01

Electrical characteristics of leakage current paths in vertical-type n-GaN Schottky barrier diodes (SBDs) on free-standing GaN substrates are investigated by using photon emission microscopy (PEM). The PEM mapping shows that the initial failure of the SBD devices at low voltages is due to the leakage current paths from polygonal pits in the GaN epilayers. It is observed that these polygonal pits originate from carbon impurity accumulation to the dislocations with a screw-type component by microstructure analysis. For the SBD without polygonal pits, no initial failure is observed and the first leakage appeals at the edge of electrodes as a result of electric field concentration. The mechanism of leakage at pits is explained in terms of trap assisted tunneling through fitting current-voltage characteristics.

The use of biodegradable plates and screws to stabilize facial fractures.

PubMed

Bell, R Bryan; Kindsfater, Craig S

2006-01-01

The purpose of this preliminary retrospective study was to review the demographics and outcome of patients with a variety of facial fractures that were stabilized with PL bone plates and screws. The records of 295 consecutive patients with facial fractures treated by open reduction and internal fixation, performed by the author from 2001 through 2004, were retrospectively reviewed. Patients were selected to receive biodegradable fixation on the basis of mechanism of injury, the degree of bony displacement demonstrated on clinical and radiographic examination, patient age, and fracture pattern or location. Outcome measures such as infection, non-union, and mal-union were identified and subjectively assessed. Descriptive statistics were recorded and analyzed. Two hundred eighty-one patients met the criteria for inclusion in the study with follow-up of 3 weeks to 3 years. Fifty-nine (21%) patients were identified as having received biodegradable plates and screws. All patients eventually went on to satisfactory healing with favorable restoration of form and function. Complications occurred in 16 patients overall (6%). Of these, 2 patients were treated with resorbable plates and screws; 1 patient with a zygomatico-maxillary complex fracture developed a sterile abscess that presented 1 year postoperatively and responded to local measures. Another patient with a Le Fort I fracture developed an anterior open bite necessitating Le Fort I osteotomy for correction. Favorable healing can be observed through the use of biodegradable PL plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood.

Late Complication of Surgically Treated Atlantoaxial Instability: Occipital Bone Erosion Induced by Protruded Fixed Titanium Rod: A Case Report

PubMed Central

Nakao, Yaoki; Shimokawa, Nobuyuki; Morisako, Hiroki; Tsukazaki, Yuji; Terada, Aiko; Nakajo, Kosuke; Fu, Yoshihiko

2014-01-01

Objective Polyaxial screw-rod fixation of C1-C2 is a relatively new technique to treat atlantoaxial instability, and there have been few reports in the literature outlining all possible complications. The purpose of this case report is to present the occurrence and management of occipital bone erosion induced by the protruded rostral part of a posterior atlantoaxial screw-rod construct causing headache. Clinical Features A 70-year-old Asian man with rheumatoid arthritis initially presented to our institution with atlantoaxial instability causing progressive quadraparesis and neck pain. Intervention and Outcome Posterior atlantoaxial instrumented fixation using C1 lateral mass screws in conjunction with C2 pedicle screws was performed to stabilize these segments. Postoperatively, the patient regained the ability to independently walk and had no radiographic evidence of instrumentation hardware failure and excellent sagittal alignment. However, despite a well-stabilized fusion, the patient began to complain of headache during neck extension. Follow-up imaging studies revealed left occipital bone erosion induced by a protruded titanium rod fixed with setscrews. During revision surgery, the rod protrusion was modified and the headaches diminished. Conclusion This case demonstrates that occipital bone erosion after posterior atlantoaxial fixation causing headache may occur. The principal cause of bone erosion in this case was rod protrusion. Although posterior atlantoaxial fixation using the screw-rod system was selected to manage atlantoaxial instability because it has less complications than other procedures, surgeons should pay attention that the length of the rod protrusion should not exceed 2 mm. PMID:25435842

21 CFR 872.4880 - Intraosseous fixation screw or wire.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intraosseous fixation screw or wire. 872.4880... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4880 Intraosseous fixation screw or wire. (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be inserted...

21 CFR 872.4880 - Intraosseous fixation screw or wire.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intraosseous fixation screw or wire. 872.4880... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4880 Intraosseous fixation screw or wire. (a) Identification. An intraosseous fixation screw or wire is a metal device intended to be inserted...

77 FR 42318 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... regarding the classification of posterior cervical screws, including pedicle and lateral mass screws. Cervical pedicle and lateral mass screws are components of rigid, posterior spinal screw and rod systems... neck pain confirmed by radiographic studies), trauma, deformity, failed previous fusion, tumor...

Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature.

PubMed

Toro, Giuseppe; Moretti, Antimo; Toro, Gabriella; Tirelli, Assunta; Calabrò, Giampiero; Toro, Antonio; Iolascon, Giovanni

2017-01-01

A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed. To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging. The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.

Computation and visualization of uncertainty in surgical navigation.

PubMed

Simpson, Amber L; Ma, Burton; Vasarhelyi, Edward M; Borschneck, Dan P; Ellis, Randy E; James Stewart, A

2014-09-01

Surgical displays do not show uncertainty information with respect to the position and orientation of instruments. Data is presented as though it were perfect; surgeons unaware of this uncertainty could make critical navigational mistakes. The propagation of uncertainty to the tip of a surgical instrument is described and a novel uncertainty visualization method is proposed. An extensive study with surgeons has examined the effect of uncertainty visualization on surgical performance with pedicle screw insertion, a procedure highly sensitive to uncertain data. It is shown that surgical performance (time to insert screw, degree of breach of pedicle, and rotation error) is not impeded by the additional cognitive burden imposed by uncertainty visualization. Uncertainty can be computed in real time and visualized without adversely affecting surgical performance, and the best method of uncertainty visualization may depend upon the type of navigation display. Copyright © 2013 John Wiley & Sons, Ltd.

Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing: biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw-plate fixation technique.

PubMed

Koller, Heiko; Schmoelz, Werner; Zenner, Juliane; Auffarth, Alexander; Resch, Herbert; Hitzl, Wolfgang; Malekzadeh, Davud; Ernstbrunner, Lukas; Blocher, Martina; Mayer, Michael

2015-12-01

A high rate of complications in multilevel cervical surgery with corpectomies and anterior-only screw-and-plate stabilization is reported. A 360°-instrumentation improves construct stiffness and fusion rates, but adds the morbidity of a second approach. A novel ATS-technique (technique that used anterior transpedicular screw placement) was recently described, yet no study to date has analyzed its performance after fatigue loading. Accordingly, the authors performed an analysis of construct stiffness after fatigue testing of a cervical 2-level corpectomy model reconstructed using a novel anterior transpedicular screw-and-plate technique (ATS-group) in comparison to standard antero-posterior instrumentation (360°-group). Twelve fresh-frozen human cervical spines were mounted on a spine motion tester to analyze restriction of ROM under loading (1.5 Nm) in flexion-extension (FE), axial rotation (AR), and lateral bending (LB). Testing was performed in the intact state, and after instrumentation of a 2-level corpectomy C4 + C5 using a cage and the constructs of ATS- and 360°-group, after 1,000 cycles, and after 2,000 cycles of fatigue testing. In the ATS-group (n = 6), instrumentation was achieved using a customized C3-C6 ATS-plate system. In the 360°-group (n = 6), instrumentation consisted of a standard anterior screw-and-plate system with a posterior instrumentation using C3-C6 lateral mass screws. Motion data were assessed as degrees and further processed as normalized values after standardization to the intact ROM state. Specimen age and BMD were not significantly different between the ATS- and 360°-groups. After instrumentation and 2,000 cycles of testing, no specimen exhibited a ROM greater than in the intact state. No specimen exhibited catastrophic construct failure after 2,000 cycles. Construct stiffness in the 360°-group was significantly increased compared to the ATS-group for all loading conditions, except for FE-testing after instrumentation. After 2,000 cycles, restriction of ROM under loading in FE was 39.8 ± 30% in the ATS-group vs. 2.8 ± 2.3% in the 360°-group, in AR 60.4 ± 25.8 vs 15 ± 11%, and in LB 40 ± 23.4 vs 3.9 ± 1.2%. Differences were significant (p < 0.05). 360°-instrumentation resembles the biomechanical standard of reference for stabilization of 2-level corpectomies. An ATS-construct was also shown to confer high construct stiffness, significantly reducing the percentage ROM beyond that of an intact specimen after 2,000 cycles. This type of instrumentation might be a clinical valuable and biomechanically sound adjunct to multilevel anterior surgical procedures.

Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations.

PubMed

Tan, Quan-Chang; Wu, Jian-Wei; Peng, Fei; Zang, Yuan; Li, Yang; Zhao, Xiong; Lei, Wei; Wu, Zi-Xiang

2016-06-01

OBJECTIVE This study investigated the optimum injection volume of polymethylmethacrylate (PMMA) to augment a novel fenestrated pedicle screw (FPS) with diameter-tapered perforations in the osteoporotic vertebral body, and how the distribution characteristics of PMMA affect the biomechanical performance of this screw. METHODS Two types of FPSs were designed (FPS-A, composed of 6 perforations with an equal diameter of 1.2 mm; and FPS-B, composed of 6 perforations each with a tapered diameter of 1.5 mm, 1.2 mm, and 0.9 mm from tip to head. Each of 28 human cadaveric osteoporotic vertebrae were randomly assigned to 1 of 7 groups: FPS-A1.0: FPS-A+1.0 ml PMMA; FPS-A1.5: FPS-A+1.5 ml PMMA; FPS-A2.0: FPS-A+2.0 ml PMMA; FPS-B1.0: FPS-B+1.0 ml PMMA; FPS-B1.5: FPS-B+1.5 ml PMMA; FPS-B2.0: FPS-B+2.0 ml PMMA; and conventional pedicle screws (CPSs) without PMMA. After the augmentation, 3D CT was performed to assess the cement distribution characteristics and the cement leakage rate. Axial pullout tests were performed to compare the maximum pullout force thereafter. RESULTS The CT construction images showed that PMMA bone cement formed a conical mass around FPS-A and a cylindrical mass around FPS-B. When the injection volume was increased from 1.0 ml to 2.0 ml, the distribution region of the PMMA cement was enlarged, the PMMA was distributed more posteriorly, and the risk of leakage was increased. When the injection volume reached 2.0 ml, the risk of cement leakage was lower for screws having diameter-tapered perforations. The pullout strengths of the augmented FPS-A groups and FPS-B groups were higher than that of the CPS group (p < 0.0001). All FPS-B groups had a higher pullout strength than the FPS-A groups. CONCLUSIONS The diameter of the perforations affects the distribution of PMMA cement. The diameter-tapered design enabled PMMA to form larger bone-PMMA interfaces and achieve a relatively higher pullout strength, although statistical significance was not reached. Study results indicated 1.5-ml of PMMA was a conservative volume for PMMA augmentation; more cement injection would significantly increase the risk of cement leakage.

Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques.

PubMed

Pishnamaz, Miguel; Wilkmann, Christoph; Na, Hong-Sik; Pfeffer, Jochen; Hänisch, Christoph; Janssen, Max; Bruners, Philipp; Kobbe, Philipp; Hildebrand, Frank; Schmitz-Rode, Thomas; Pape, Hans-Christoph

2016-01-01

Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures. Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05. 160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001). Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.

Early results using a biodegradable magnesium screw for modified chevron osteotomies.

PubMed

Plaass, Christian; Ettinger, Sarah; Sonnow, Lena; Koenneker, Soeren; Noll, Yvonne; Weizbauer, Andreas; Reifenrath, Janin; Claassen, Leif; Daniilidis, Kiriakos; Stukenborg-Colsman, Christina; Windhagen, Henning

2016-12-01

This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Simulated lumbar minimally invasive surgery educational model with didactic and technical components.

PubMed

Chitale, Rohan; Ghobrial, George M; Lobel, Darlene; Harrop, James

2013-10-01

The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography-navigated guidance also improved from 28.3 to 26.6. Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

The experiment of magnesium ECAP miniplate as alternative biodegradable material (on male white New Zealand rabbits)

NASA Astrophysics Data System (ADS)

Wiwanto, Siska; Sulistyani, Lilies Dwi; Latief, Fourier Dzar Eljabbar; Supriadi, Sugeng; Priosoeryanto, Bambang Pontjo; Latief, Benny Syariefsyah

2018-02-01

Study of biodegradations of Magnesium ECAP (Equal Channel Angular Pressing) miniplate in the osteosynthesis system has been used as a new material for plate and screw in oral and maxillofacial surgery. This miniplate and screw that were made of Magnesium ECAP were implanted in the femurs of New Zealand rabbits. The degradation process was detected through pocket gas that appeared in hard and soft tissues surrounding in the implanted miniplates and screws. From the changes on the tissues, we can assess the biodegradation process by measuring the gas pocket through micro-CT Scan. Upon the first month of study we euthanized the rabbits and made a micro-CT Scan to see how far the effect of the gas pocket was. Histological analyses were performed to investigate the local tissue response adjacent to the Magnesium ECAP miniplates. We analyzed the femur of a rabbit a month, three months, and five months after implantation. The result showed a degradation rate in the implanted Magnesium ECAP miniplate of 0.61±0.39 mm/year. Unlike the screws, miniplates have higher water content and blood flow than bone, therefore they degrade faster. This study shows promising results for further development of Magnesium ECAP and in the production of osteosynthesis material for rigid fixation in Oral and Maxillofacial skeleton.