scholarly journals Salvaging Pull-Out Strength in a Previously Stripped Screw Site: A Comparison of Three Rescue Techniques

2021 ◽  
Vol 6 (3) ◽  
pp. 71
Author(s):  
Francesco Addevico ◽  
Giovanni F. Solitro ◽  
Massimo Max Morandi
Keyword(s):  
Cancellous Bone ◽  
Bone Healing ◽  
Common Occurrence ◽  
Intraoperative Complication ◽  
Bone Fixation ◽  
Pull Out ◽  
Thread Length ◽  
Different Dimensions ◽  
Pull Out Strength

Screw stripping during bone fixation is a common occurrence during operations that results in decreased holding capacity and bone healing. We aimed to evaluate the rescue of the stripped screw site using screws of different dimensions. Five screw configurations were tested on cadaveric specimens for pull-out strength (POS). The configurations included a control screw tightened without stripping, a configuration voluntarily stripped and left in place, and three more configurations in which the stripped screws were replaced by a different screw with either increased overall length, diameter, or thread length. Each configuration was tested five times, with each screw tested once. The POS of the control screw, measured to be 153.6 ± 27 N, was higher than the POS measured after stripping and leaving the screw in place (57.1 ± 18 N, p = 0.001). The replacement of the stripped screw resulted in a POS of 158.4 ± 64 N for the screw of larger diameter, while the screws of the same diameter but increased length or those with extended thread length yielded POS values of 138.4 ± 42 and 185.7 ± 48 N, respectively. Screw stripping is a frequent intraoperative complication that, according to our findings, cannot be addressed by leaving the screw in place. The holding capacity of a stripped screw implanted in cancellous bone can successfully be restored with a different screw of either larger diameter, longer length, or extended thread length.

Axial pull-out strength of 3.5 cortical and 4.0 cancellous bone screws placed in canine proximal tibias using manual and power tapping

2008 ◽  
Vol 21 (04) ◽  
pp. 323-328 ◽  
Author(s):  
M. E. Soniat ◽  
S. Elder ◽  
R. McLaughlin ◽  
J. L. Demko
Keyword(s):  
Cancellous Bone ◽  
Testing Machine ◽  
Bone Screws ◽  
Materials Testing ◽  
Pull Out ◽  
Cortical Width ◽  
Bone Width ◽  
Significant Difference ◽  
Pull Out Strength

SummaryAn in vitro experimental cadaveric mechanical testing study was performed using 20 radiographically mature dogs, weighing between 18–33 kg. The aim of the study was to compare the axial pull-out strength of 3.5 mm cortical and 4.0 mm cancellous bone screws inserted in the canine proximal tibia using manual and power tapping techniques. 3.5 cortical and 4.0 cancellous bone screws were inserted in canine cadaver proximal tibiae using a manual or power tapping technique. The screws were extracted using a servohydraulic materials testing machine in order to measure axial pullout strength. Axial pull-out strength was recorded relative to the total bone width and total cortical width of each tibia. The mean axial pull-out strength for all constructs was 717.8±56.5 N without any statistically significant difference among groups (p=0.4183). The groups were equal in animal body weight, cortical width and total bone width (p=0.2808). The axial pull-out strength in proportion to cortical and total bone width was not significantly different among groups (p=0.5318). Axial pull-out strengths of 3.5 mm cortical and 4.0 mm cancellous bone screws inserted in the proximal tibial metaphysis were not significantly different. Axial pull-out strength was not affected by the use of power tapping in either screw type.

Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength

2014 ◽  
Vol 25 (6) ◽  
pp. 1714-1720 ◽  
Author(s):  
Julian L. Wichmann ◽  
Christian Booz ◽  
Stefan Wesarg ◽  
Ralf W. Bauer ◽  
J. Matthias Kerl ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Pedicle Screw ◽  
Bone Mineral ◽  
Cancellous Bone ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Mineral Density ◽  
Pull Out ◽  
Pull Out Strength

Influence of thermodisinfection and duration of cryopreservation at different temperatures on pull out strength of cancellous bone

2014 ◽  
Vol 16 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Christian Fölsch ◽  
Wolfram Mittelmeier ◽  
Thomas von Garrel ◽  
Uwe Bilderbeek ◽  
Nina Timmesfeld ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Pull Out ◽  
Different Temperatures ◽  
Pull Out Strength

scholarly journals Optimal Screw Fixation in Treating Jones Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Ali Hosseini ◽  
Pim Van Dijk ◽  
Sofie Breuking ◽  
Bryan Vopat ◽  
Daniel Guss ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Screw Placement ◽  
Bone Length ◽  
Pull Out ◽  
Screw Length ◽  
Intramedullary Canal ◽  
Thread Length ◽  
The Mean ◽  
Pull Out Strength

Category: Midfoot/Forefoot Introduction/Purpose: Jones fractures are among the most common fractures in the foot, mainly occurring in athletes. In order to facilitate return to sport and good functional outcomes, management with intramedullary screw fixation is often recommended [1-3]. While optimal screw dimension and location parameters have varied in the literature, it is clear that maximizing pull-out strength, providing adequate compression across the fracture, and minimizing irritation to surrounding soft tissue structures are of paramount importance. The aim of this study was to improve our guidelines regarding optimal insertion trajectory and screw parameters of Jones fractures by more accurately defining the bony and soft tissue anatomy of the fifth metatarsal bone and its intramedullary canal. Methods: 21 fifth metatarsal bones were harvested from cadaveric feet. Three reference screws were placed on each bone for registration. 3D CT model of each bone with outer cortex, intramedullary canal and the articular cortex was created (Figure A). The insertions of the PB and PF and the reference screws of each bone were carefully digitized and mapped onto corresponding 3D model. The anatomic insertions and the surface areas were determined. Based on the length of the bone, the shape of the intramedullary canal, and the diameter of the canal at its narrowest point, the perceived ideal screw and placement was then modulated for each bone model. Also, the fracture zone where Jones fractures occur was determined (Figure B) based on Lawrence/Botte classification [1]. Screw and thread length were calculated in this position, and the impact of screw placement on the insertion sites of both the PB and PF were recorded. Results: The mean length of the bones was 74.4±3.6 mm, with the narrowest diameter of the intramedullary canal being 4.3±0.7 mm. Ideal screw position was identified as parallel to the cuboid and coaxial with the intramedullary cortex; this placement, however, was found to partially sacrifice the PB and PF insertions in 62% (13/21) and 33% (7/21) of cases, respectively; with an average of 1.6±0.8 mm of the PB and 1.3±0.8 mm of the PF insertion. The mean ideal screw length in this position was found to be 47.8±5.8 mm, with a minimal thread length of 28±6.8 mm and a minimal diameter of 4.5 mm (Figure B). The ratio of screw length to the total bone length was 0.64 (range 0.50-0.72). Conclusion: In order to maximize compression and pull-out strength and minimize sacrifice of the adjacent soft tissue structures during screw placement, Jones fractures should be fixed with hardware parallel to the cuboid and collinear with the intramedullary cortex—which mitigates but does not avoid injury to the peroneal tendon and plantar fascia. Average optimal length of the screw should be 64% of the length of the bone, with a minimum 4.5 mm diameter and 50% thread length (relative to bone length). Given variability in metatarsal anatomy, screw choice should be tailored to the individual.

scholarly journals Ibudilast Mitigates Delayed Bone Healing Caused by Lipopolysaccharide by Altering Osteoblast and Osteoclast Activity

2021 ◽  
Vol 22 (3) ◽  
pp. 1169
Author(s):  
Yuhan Chang ◽  
Chih-Chien Hu ◽  
Ying-Yu Wu ◽  
Steve W. N. Ueng ◽  
Chih-Hsiang Chang ◽  
...  
Keyword(s):  
Cell Wall ◽  
Bone Formation ◽  
Cancellous Bone ◽  
Bone Healing ◽  
Bone Bridge ◽  
Cell Wall Components ◽  
Osteoclast Activity ◽  
Wall Components

Bacterial infection in orthopedic surgery is challenging because cell wall components released after bactericidal treatment can alter osteoblast and osteoclast activity and impair fracture stability. However, the precise effects and mechanisms whereby cell wall components impair bone healing are unclear. In this study, we characterized the effects of lipopolysaccharide (LPS) on bone healing and osteoclast and osteoblast activity in vitro and in vivo and evaluated the effects of ibudilast, an antagonist of toll-like receptor 4 (TLR4), on LPS-induced changes. In particular, micro-computed tomography was used to reconstruct femoral morphology and analyze callus bone content in a femoral defect mouse model. In the sham-treated group, significant bone bridge and cancellous bone formation were observed after surgery, however, LPS treatment delayed bone bridge and cancellous bone formation. LPS inhibited osteogenic factor-induced MC3T3-E1 cell differentiation, alkaline phosphatase (ALP) levels, calcium deposition, and osteopontin secretion and increased the activity of osteoclast-associated molecules, including cathepsin K and tartrate-resistant acid phosphatase in vitro. Finally, ibudilast blocked the LPS-induced inhibition of osteoblast activation and activation of osteoclast in vitro and attenuated LPS-induced delayed callus bone formation in vivo. Our results provide a basis for the development of a novel strategy for the treatment of bone infection.

scholarly journals The effect of tissue culture on suture holding strength and degradation in canine tendon

2009 ◽  
Vol 34 (5) ◽  
pp. 643-650 ◽  
Author(s):  
H. OMAE ◽  
C. ZHAO ◽  
Y.-L. SUN ◽  
M. E. ZOBITZ ◽  
S. L. MORAN ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Tensile Load ◽  
Flexor Digitorum Profundus ◽  
Tendon Suture ◽  
Pull Out ◽  
Culture Model ◽  
Static Tensile ◽  
Tissue Culture Model ◽  
Flexor Digitorum ◽  
Pull Out Strength

The purpose of this study was to assess tendon metabolism and suture pull-out strength after simple tendon suture in a tissue culture model. One hundred and twelve flexor digitorum profundus tendons from 28 dogs were cultured for 7, 14, or 21 days with or without a static tensile load. In both groups increased levels of matrix metalloproteinase (MMP) mRNA was noted. Suture pull-out strength did not decrease during tissue culture. While the presence of a static load had no effect on the pull-out strength, it did affect MMP mRNA expression. This tissue culture model could be useful in studying the effect of factors on the tendon-suture interface.

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