Há diferença na força de compressão interfragmentar entre parafusos com rosca total ou parcial? Resultados de um estudo biomecânico experimental piloto

Tosan Okoro; Marcus Landgren; Edem Afenu; Gabriele Russow; Dag Wulsten; Mark Heyland

doi:10.1055/s-0042-1750828

Revista Brasileira de Ortopedia, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 231-239
DOI: 10.1055/s-0042-1750828

Artigo Original

Trauma

Is there a Difference in Interfragmentary Compression Strength Between Fully or Partially Threaded Screws? Results of an Experimental Biomechanical Pilot Study

Artikel in mehreren Sprachen: português | English

Tosan Okoro

¹Departamento de Artroplastia, Fundação Ortopédica Robert Jones e Agnes Hunt Hospital NHS Trust, Gobowen, Oswestry SY10 7AG, Reino Unido

,

Marcus Landgren

²Departamento de Cirurgia Ortopédica, Unidade de Cirurgia de Mão, Hospital Universitário de Copenhague - Herlev e Gentofte, Gentofte, Dinamarca

³Departamento de Clínica Médica, Universidade de Copenhague, Copenhagen, Dinamarca

,

Edem Afenu

⁴Universidade de Toronto, Faculdade de Medicina, 1 Kings College Circle, Toronto M4Y 2V6, Ontario, Canadá

,

Gabriele Russow

⁵Charité – Universidade de Medicina de Berlim, Centro de Cirurgia Musculoesquelética, Berlim, Alemanha

⁶Instituto de Saúde de Berlim em Charité - Universidade de Medicina de Berlim, Instituto Julius Wolff de Biomecânica e Regeneração Musculoesquelética, Berlim, Alemanha

,

Dag Wulsten

⁶Instituto de Saúde de Berlim em Charité - Universidade de Medicina de Berlim, Instituto Julius Wolff de Biomecânica e Regeneração Musculoesquelética, Berlim, Alemanha

,

Mark Heyland

⁶Instituto de Saúde de Berlim em Charité - Universidade de Medicina de Berlim, Instituto Julius Wolff de Biomecânica e Regeneração Musculoesquelética, Berlim, Alemanha

› Institutsangaben

Abstract

Objective This study assessed differences between fully- and partially-threaded screws in the initial interfragmentary compression strength. Our hypothesis was that there would be an increased loss in initial compression strength with the partially-threaded screw.

Methods A 45-degree oblique fracture line was created in artificial bone samples. The first group (FULL, n = 6) was fixed using a 3.5-mm fully-threaded lag screw, while the second group (PARTIAL, n = 6) used a 3.5-mm partially-threaded lag screw. Torsional stiffness for both rotational directions were evaluated. The groups were compared based on biomechanical parameters: angle-moment-stiffness, time-moment-stiffness, maximal torsional moment (failure load), and calibrated compression force based on pressure sensor measurement.

Results After loss of one PARTIAL sample, no statistically significant differences in calibrated compression force measurement were observed between both groups: [median (interquartile range)] FULL: 112.6 (10.5) N versus PARTIAL: 106.9 (7.1) N, Mann-Whitney U-test: p = 0.8). In addition, after exclusion of 3 samples for mechanical testing (FULL n = 5, PARTIAL n = 4), no statistically significant differences were observed between FULL and PARTIAL constructs in angle-moment-stiffness, time-moment-stiffness, nor maximum torsional moment (failure load).

Conclusion There is no apparent difference in the initial compression strength (compression force or construct stiffness or failure load) achieved using either fully- or partially-threaded screws in this biomechanical model in high-density artificial bone. Fully-threaded screws could, therefore, be more useful in diaphyseal fracture treatment. Further research on the impact in softer osteoporotic, or metaphyseal bone models, and to evaluate the clinical significance is required.

Keywords

biomechanical phenomena - bone cements - bone screws - fractures, bone

Volltext

Referenzen

Referências
1 Roberts TT, Prummer CM, Papaliodis DN, Uhl RL, Wagner TA. History of the orthopedic screw. Orthopedics 2013; 36 (01) 12-14
2 Downey MW, Kosmopoulos V, Carpenter BB. Fully Threaded Versus Partially Threaded Screws: Determining Shear in Cancellous Bone Fixation. J Foot Ankle Surg 2015; 54 (06) 1021-1024
3 Singh AP. Interfragmentary Screw or Lag Screw Fixation. [Accessed 17th December 2019]. Available from: https://boneandspine.com/interfragmentary-screw-or-lag-screw/#lag-screw-principle
4 Eastman J, Deafenbaugh B, Christiansen B, Garcia-Nolen T, Lee M. Achieving interfragmentary compression without special drilling technique or screw design. J Orthop Res 2018; 36 (04) 1099-1105
5 Rao E, Naveen S, Rao RC, Kollabathula K, Srirambhatla M, Gandham S. Principle of Lag-Screw Fixation in Mandibular Trauma. J Int Soc Prev Community Dent 2019; 9 (03) 282-289
6 Giles JB, DeLee JC, Heckman JD, Keever JE. Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am 1982; 64 (06) 864-870
7 Vijimohan SJ, Haque S, Ellis D. An Alternate Technique of Applying Lag Screw for Fixation of Distal Fibula Fracture: Posterior to Anterior Interfragmentary Compression Screw. Foot Ankle Spec 2017; 10 (06) 555-559
8 Mencio GA, Swiontkowski MF, Green NE. Green's skeletal trauma in children. 6 ^th ed. Philadelphia: Elsevier/Saunders; 2015
9 Greiwe M. Ed. Shoulder and elbow trauma and its complications. Volume 2: The elbow. New York: Elsevier; 2015
10 Sheth NP, Lonner JH. Gowned and Gloved Orthopaedics: Introduction to Common Procedures. Philadelphia: Elsevier/Saunders; 2009
11 Miyanji F, Mahar A, Oka R, Pring M, Wenger D. Biomechanical comparison of fully and partially threaded screws for fixation of slipped capital femoral epiphysis. J Pediatr Orthop 2008; 28 (01) 49-52
12 Bulut T, Gursoy M, Ertem H. Fully threaded headless compression screw versus partially threaded cancellous lag screw in medial malleolus fractures: clinical and radiological outcomes. Eur J Trauma Emerg Surg 2021; 47 (01) 179-185
13 Kassi JP, Hoffmann JE, Heller M, Raschke M, Duda GN. Bewertung der Stabilität von Frakturfixationssystemen: Mechanische Vorrichtung zur Untersuchung der 3-D-Steifigkeit in vitro. Biomed Tech (Berl) 2001; 46 (09) 247-252
14 Duda G. Muskuloskelettale Belastungen: Beitrag zu den mechanischen Rahmenbedingungen der Frakturheilung. Charité; 2001
15 Crosbie S, Corliss D. Are you dense? using kernel density estimation (kde) to connect the dots amidst uncertainty (Paper DV-06–2012). Presented at: MWSUG Conference; 2012. Available from: https://www.mwsug.org/proceedings/2012/DV/MWSUG-2012-DV06.pdf
16 Rozell JC, Chin M, Donegan DJ, Hast MW. Biomechanical Comparison of Fully Threaded Solid Cortical Versus Partially Threaded Cannulated Cancellous Screw Fixation for Lisfranc Injuries. Orthopedics 2018; 41 (02) e222-e227
17 Salduz A, Birisik F, Polat G, Bekler B, Bozdag E, Kilicoglu O. The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study. J Orthop Surg Res 2016; 11 (01) 146
18 Keltz E, Mora AJ, Wulsten D. et al. Is initial interfragmentary compression made to last? An ovine bone in vitro study. Injury 2021; 52 (06) 1263-1270
19 Hart A, Harvey EJ, Rabiei R, Barthelat F, Martineau PA. Fixation strength of four headless compression screws. Med Eng Phys 2016; 38 (10) 1037-1043
20 Miles MR, Green T, Parks BG, Thakkar MY, Segalman KA, Means Jr KR. Comparison of Lag Versus Nonlag Screw Fixation for Long Oblique Proximal Phalanx Fractures: A Biomechanical Study. J Hand Surg Am 2021:S0363-5023(21)00334-8
21 Bottlang M, Doornink J, Fitzpatrick DC, Madey SM. Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. J Bone Joint Surg Am 2009; 91 (08) 1985-1994
22 Heyland M, Duda GN, Haas NP. et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury 2015; 46 (Suppl. 04) S24-S32
23 Shannon SF, Oppizzi G, Schloss MG. et al. Do Fully Threaded Transiliac-Transsacral Screws Improve Mechanical Stability of Vertically Unstable Pelvic Fractures? A Cadaveric Biomechanical Analysis. J Orthop Trauma 2021; 35 (01) e18-e24
24 Srinivasan A, Young M, Ambrose C, Kellam J. Maintenance of Compression With a Positional Screw Versus Compression Generated With a Lag Screw. J Orthop Trauma 2019; 33 (11) 564-568