Subscribe to RSS
DOI: 10.1055/s-0038-1632679
The influence of screw torque in the application of bone plates
This project was supported by a grant from the Mohill Orthopaedic Research Initiative and the EP Taylor Equine Research Fund, Ontario, Canada. The authors are grateful to Synthes Canada (Mississauga, Ontario) for assistance in the provision of orthopaedic equipment.Publication History
Received
20 April 2000
Accepted
14 September 2000
Publication Date:
09 February 2018 (online)
Summary
The applied level of screw torque has a significant impact on both the mechanical and vascular environment in bone following the application of a bone plate. The amount of torque applied dictates the resultant level of axial tension generated in the screw and the compressive forces between the plate and underlying bone. The interface contact area between the plate and underlying bone is also affected. As a consequence, screw torque can be implicated in the pathogenesis of implant induced osteopenia and other pathological occurrences that follow bone plate fixation.
The work performed was designed to evaluate the effect of the applied level of screw torque. The construction stiffness (rigidity) and bone surface strain was quantitated in response to variable levels of screw torque. This was performed utilizing intact and osteotomized cadaveric bone.
The current level of screw torque applied in the clinical situation, for 4.5 mm cortical screws, is approximately 5 Newton metres (Nm). It appears from the work presented herein, that lowering the level of applied screw torque does not adversely affect the rigidity of the final construction. This fact may serve to ameliorate the pathological consequences of applying screws and plates using current clinical criteria.
The amount of torque applied to screws in the application of bone plates has a profound effect on a number of elements, namely the interface contact area and force. The work presented examines the effect of screw torque on the rigidity and bone strain distribution of fractured bone following bone plate reconstruction. It appears that the use of lower levels of screw torque, than currently used in clinical practice, does not adversely effect the rigidity of the final construction. These findings support the notion that the level of screw torque applied may have a role in ameliorating the pathogenic response that occur following bone plate application, namely osteopaenia.
-
REFERENCES
- 1 Field JR, Hearn TC, Caldwell CB. Bone plate fixation: An evaluation of interface contact area and force of the Dynamic Compression Plate and the Limited Contact- Dynamic Compression Plate applied to cadaveric bone. J Orthop Trauma 1997; 11 (05) 368-73.
- 2 Field JR, Hearn TC, Caldwell CB. The influence of screw torque, object radius of curvature, mode of bone plate application and bone plate design on bone-plate interface mechanics. Injury 1997; 29 (03) 233-41.
- 3 Cordey J, Rahn BA, Perren SM. Human torque control in the use of bone screws. Current concepts of internal fixation of fractures. Uhthoff HK. (ed). Berlin: Springer-Verlag; 1980: 235-43.
- 4 Field JR. Screw torque and interfragmentary compression in equine cadaver longbone fractures. Vet Comp Orthop Traumatol 1993; 06: 163-5.
- 5 Field JR, McKee S. Screw torque and bone plate fixation to equine cadaver longbones. Vet Comp Orthop Traumatol 1996; 09: 1-3.
- 6 Nunnamaker DM, Perren SM. Force measurements in screw fixation. J Biomech 1976; 09: 669-75.
- 7 Beaupre GS, Carter DR, Orr TE. et al. Stresses in plated longbones: The role of screw tightness and interface slipping. J Orthop Res 1988; 06 (01) 39-50.
- 8 Carter DR, Shimaoka EE, Harris WH. et al. Changes in long bone structural properties during the first 8 weeks of plate implantation. J Orthop Res 1984; 02: 80-9.
- 9 Matter P, Brennwald J, Perren SM. The effect of static compression and tension on internal remodelling of cortical bone. Helvetica Chirurgica Acta. Suppl 12, 1975
- 10 Cheal EJ, Hayes WC, White AA. et al. Stress analysis of a simplified compression plate fixation system for fractured bones. Comput Struct 1983; 17: 845-55.
- 11 Simon BR, Woo SL-Y, Stanley GM. et al. Evaluation of one-, two- and three-dimensional finite element and experimental models of internal fixation plates. J Biomech 1977; 10: 79-86.
- 12 Perren SM, Cordey J, Rahn BA. et al. Early temporary porosis of bone induced by internal fixation implants. A reaction to necrosis, not stress protection? Clin Orthop Rel Res 1988; 232: 139-51.
- 13 Uhthoff HK, Boisvert D, Finnegan M. Cortical porosis under plates. Reaction to unloading or to necrosis. J Bone Joint Surg 1994; 76-A (10) 1507-12.
- 14 Waelclhi-Suter C. Vascular changes in cortical bone following intramedullary fixation: Current concepts of internal fixation of fractures. Uhthoff HK. (ed). Berlin: Springer-Verlag; 1980: 411-5.
- 15 Gotzen L, Haas N, Hutter J. Biomechanical studies of torque and force of the 4.5 mm AO cortex screw as a lag screw. Current concepts of internal fixation of fractures. Uhthoff HK. (ed). Berlin: Springer-Verlag; 1980: 259-67.
- 16 von Arx Ch. Schubübertragung durch Reibung bei Plattenosteosynthesen. Med Thesis, Bern 1973. AO Bulletin 1975.
- 17 Ganz R, Mast J, Weber BG, Perren SM. Clinical aspects of ‘bio-379 logical’ plating. Injury 1991; 22 (Suppl. 01) 4-8.
- 18 Gerber C, Mast J, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg 1990; 109: 295-303.
- 19 Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orth Rel Res 1979; 138: 175-86.