Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates
Screws are the most commonly inserted orthopaedic implants. However, several variables related to screw insertion and tightening have not been evaluated. This study aimed firstly to assess the effect of insertion variables on screw tightness, secondly to improve methodologies used by researchers whe...
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| Veröffentlicht in: | Clinical biomechanics (Bristol) 2020-12, Vol.80, p.105201-105201, Article 105201 |
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| creator | Fletcher, James W.A. Neumann, Verena Wenzel, Lisa Gueorguiev, Boyko Richards, R. Geoff Gill, Harinderjit S. Whitehouse, Michael R. Preatoni, Ezio |
| description | Screws are the most commonly inserted orthopaedic implants. However, several variables related to screw insertion and tightening have not been evaluated. This study aimed firstly to assess the effect of insertion variables on screw tightness, secondly to improve methodologies used by researchers when testing screw insertion techniques and thirdly to assess for any learning or fatigue effects when inserting screws.
Two surgeons tightened a total of 2280 non-locking, 3.5 mm cortical screws, with 120 screws inserted to what they felt to be optimum tightness whilst varying each of the following factors: different screwdrivers for measuring torque, screwdriver orientation, gloves usage, dominant/non-dominant hand usage, awareness to the applied torque (blinded, unblinded and re-blinded), four bone densities and seven cortical thicknesses. Screws were tightened to failure to determine stripping torque, which was used to calculate screw tightness – ratio between stopping and stripping torque.
Screw tightness increased with glove usage, being blinded to the applied torque and with denser artificial bone and with thinner cortices. Considering all the insertions performed, the two surgeons stopped tightening screws at difference values of tightness ((77% versus 66% (p |
| doi_str_mv | 10.1016/j.clinbiomech.2020.105201 |
| format | Article |
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Two surgeons tightened a total of 2280 non-locking, 3.5 mm cortical screws, with 120 screws inserted to what they felt to be optimum tightness whilst varying each of the following factors: different screwdrivers for measuring torque, screwdriver orientation, gloves usage, dominant/non-dominant hand usage, awareness to the applied torque (blinded, unblinded and re-blinded), four bone densities and seven cortical thicknesses. Screws were tightened to failure to determine stripping torque, which was used to calculate screw tightness – ratio between stopping and stripping torque.
Screw tightness increased with glove usage, being blinded to the applied torque and with denser artificial bone and with thinner cortices. Considering all the insertions performed, the two surgeons stopped tightening screws at difference values of tightness ((77% versus 66% (p < 0.001)). A learning effect was observed with some parameters including sterile gloves usage and non-dominant hand application.
Different insertion conditions frequently changed screw tightness for both surgeons. Given the influence of screw tightness on fixation stability, the variables investigated within this study should be carefully reported and controlled when performing biomechanical testing alongside practicing screw insertion under different conditions during surgical training.
•Common variables related to screw insertion impact on tightness and stripping rates.•Awareness of applied torque improves screw insertion and reduces stripping rates.•The tested variables need to be controlled for and reported during biomechanical testing.</description><identifier>ISSN: 0268-0033</identifier><identifier>EISSN: 1879-1271</identifier><identifier>DOI: 10.1016/j.clinbiomech.2020.105201</identifier><identifier>PMID: 33158573</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Biomechanical Phenomena ; Bone Screws ; Fracture Fixation, Internal - instrumentation ; Humans ; Mechanical Phenomena ; Non-locking ; Screw ; Stripping ; Tightness ; Torque</subject><ispartof>Clinical biomechanics (Bristol), 2020-12, Vol.80, p.105201-105201, Article 105201</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-4b6098e6ebe83ebf41fde773928d0a32c7af7b4878c25d2cedfe7328542438963</citedby><cites>FETCH-LOGICAL-c428t-4b6098e6ebe83ebf41fde773928d0a32c7af7b4878c25d2cedfe7328542438963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clinbiomech.2020.105201$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33158573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fletcher, James W.A.</creatorcontrib><creatorcontrib>Neumann, Verena</creatorcontrib><creatorcontrib>Wenzel, Lisa</creatorcontrib><creatorcontrib>Gueorguiev, Boyko</creatorcontrib><creatorcontrib>Richards, R. Geoff</creatorcontrib><creatorcontrib>Gill, Harinderjit S.</creatorcontrib><creatorcontrib>Whitehouse, Michael R.</creatorcontrib><creatorcontrib>Preatoni, Ezio</creatorcontrib><title>Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates</title><title>Clinical biomechanics (Bristol)</title><addtitle>Clin Biomech (Bristol, Avon)</addtitle><description>Screws are the most commonly inserted orthopaedic implants. However, several variables related to screw insertion and tightening have not been evaluated. This study aimed firstly to assess the effect of insertion variables on screw tightness, secondly to improve methodologies used by researchers when testing screw insertion techniques and thirdly to assess for any learning or fatigue effects when inserting screws.
Two surgeons tightened a total of 2280 non-locking, 3.5 mm cortical screws, with 120 screws inserted to what they felt to be optimum tightness whilst varying each of the following factors: different screwdrivers for measuring torque, screwdriver orientation, gloves usage, dominant/non-dominant hand usage, awareness to the applied torque (blinded, unblinded and re-blinded), four bone densities and seven cortical thicknesses. Screws were tightened to failure to determine stripping torque, which was used to calculate screw tightness – ratio between stopping and stripping torque.
Screw tightness increased with glove usage, being blinded to the applied torque and with denser artificial bone and with thinner cortices. Considering all the insertions performed, the two surgeons stopped tightening screws at difference values of tightness ((77% versus 66% (p < 0.001)). A learning effect was observed with some parameters including sterile gloves usage and non-dominant hand application.
Different insertion conditions frequently changed screw tightness for both surgeons. Given the influence of screw tightness on fixation stability, the variables investigated within this study should be carefully reported and controlled when performing biomechanical testing alongside practicing screw insertion under different conditions during surgical training.
•Common variables related to screw insertion impact on tightness and stripping rates.•Awareness of applied torque improves screw insertion and reduces stripping rates.•The tested variables need to be controlled for and reported during biomechanical testing.</description><subject>Biomechanical Phenomena</subject><subject>Bone Screws</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Humans</subject><subject>Mechanical Phenomena</subject><subject>Non-locking</subject><subject>Screw</subject><subject>Stripping</subject><subject>Tightness</subject><subject>Torque</subject><issn>0268-0033</issn><issn>1879-1271</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc9u1DAQxi1ERZfCKyBz45LFf5LYOaIVpUiVuFCulmNPdmfJ2sH2FngBnpukKYgjp5FmfvN9Y3-EvOZsyxlv3x63bsTQYzyBO2wFE0u_EYw_IRuuVVdxofhTsmGi1RVjUl6S5zkfGWO1aNQzciklb3Sj5Ib8-mIT2oIxZIqBhhiqMbqvGPY0uwTf52aGtMypi8HjSu4hQLIF6DlMCTy6YvsRqDvYsIdMS6TWHRDuwdMBfzzI04L7QwmQM7XB01wSTtNis-jkF-RisGOGl4_1itxdv_-8u6luP334uHt3W7la6FLVfcs6DS30oCX0Q80HD0rJTmjPrBRO2UH1tVbaicYLB34AJYVualFL3bXyirxZdacUv50hF3PC7GAcbYB4zkbUjVay0YLPaLeiLsWcEwxmSniy6afhzCwxmKP5JwazxGDWGObdV4825_4E_u_mn3-fgd0KwPzYe4RkskMI88GYwBXjI_6HzW-FS6Kp</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Fletcher, James W.A.</creator><creator>Neumann, Verena</creator><creator>Wenzel, Lisa</creator><creator>Gueorguiev, Boyko</creator><creator>Richards, R. Geoff</creator><creator>Gill, Harinderjit S.</creator><creator>Whitehouse, Michael R.</creator><creator>Preatoni, Ezio</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202012</creationdate><title>Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates</title><author>Fletcher, James W.A. ; Neumann, Verena ; Wenzel, Lisa ; Gueorguiev, Boyko ; Richards, R. Geoff ; Gill, Harinderjit S. ; Whitehouse, Michael R. ; Preatoni, Ezio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-4b6098e6ebe83ebf41fde773928d0a32c7af7b4878c25d2cedfe7328542438963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biomechanical Phenomena</topic><topic>Bone Screws</topic><topic>Fracture Fixation, Internal - instrumentation</topic><topic>Humans</topic><topic>Mechanical Phenomena</topic><topic>Non-locking</topic><topic>Screw</topic><topic>Stripping</topic><topic>Tightness</topic><topic>Torque</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fletcher, James W.A.</creatorcontrib><creatorcontrib>Neumann, Verena</creatorcontrib><creatorcontrib>Wenzel, Lisa</creatorcontrib><creatorcontrib>Gueorguiev, Boyko</creatorcontrib><creatorcontrib>Richards, R. Geoff</creatorcontrib><creatorcontrib>Gill, Harinderjit S.</creatorcontrib><creatorcontrib>Whitehouse, Michael R.</creatorcontrib><creatorcontrib>Preatoni, Ezio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical biomechanics (Bristol)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fletcher, James W.A.</au><au>Neumann, Verena</au><au>Wenzel, Lisa</au><au>Gueorguiev, Boyko</au><au>Richards, R. Geoff</au><au>Gill, Harinderjit S.</au><au>Whitehouse, Michael R.</au><au>Preatoni, Ezio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates</atitle><jtitle>Clinical biomechanics (Bristol)</jtitle><addtitle>Clin Biomech (Bristol, Avon)</addtitle><date>2020-12</date><risdate>2020</risdate><volume>80</volume><spage>105201</spage><epage>105201</epage><pages>105201-105201</pages><artnum>105201</artnum><issn>0268-0033</issn><eissn>1879-1271</eissn><abstract>Screws are the most commonly inserted orthopaedic implants. However, several variables related to screw insertion and tightening have not been evaluated. This study aimed firstly to assess the effect of insertion variables on screw tightness, secondly to improve methodologies used by researchers when testing screw insertion techniques and thirdly to assess for any learning or fatigue effects when inserting screws.
Two surgeons tightened a total of 2280 non-locking, 3.5 mm cortical screws, with 120 screws inserted to what they felt to be optimum tightness whilst varying each of the following factors: different screwdrivers for measuring torque, screwdriver orientation, gloves usage, dominant/non-dominant hand usage, awareness to the applied torque (blinded, unblinded and re-blinded), four bone densities and seven cortical thicknesses. Screws were tightened to failure to determine stripping torque, which was used to calculate screw tightness – ratio between stopping and stripping torque.
Screw tightness increased with glove usage, being blinded to the applied torque and with denser artificial bone and with thinner cortices. Considering all the insertions performed, the two surgeons stopped tightening screws at difference values of tightness ((77% versus 66% (p < 0.001)). A learning effect was observed with some parameters including sterile gloves usage and non-dominant hand application.
Different insertion conditions frequently changed screw tightness for both surgeons. Given the influence of screw tightness on fixation stability, the variables investigated within this study should be carefully reported and controlled when performing biomechanical testing alongside practicing screw insertion under different conditions during surgical training.
•Common variables related to screw insertion impact on tightness and stripping rates.•Awareness of applied torque improves screw insertion and reduces stripping rates.•The tested variables need to be controlled for and reported during biomechanical testing.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33158573</pmid><doi>10.1016/j.clinbiomech.2020.105201</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Biomechanical Phenomena Bone Screws Fracture Fixation, Internal - instrumentation Humans Mechanical Phenomena Non-locking Screw Stripping Tightness Torque |
| title | Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates |
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