Pull-out forces of headless compression screws in variations of synthetic bone models imitating different types of scaph
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CLINICAL APPLICATIONS OF BIOMATERIALS Original Research
Pull-out forces of headless compression screws in variations of synthetic bone models imitating different types of scaphoid fractures in good bone quality Jochen Erhart1 Ewald Unger2 Inga Trulson1 Michael Hagmann3 Robin Ristl3 Alexander Trulson4 Stefan Hajdu1 Philip Schefzig1 Anna Gormasz1 Winfried Mayr2 ●
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Received: 10 May 2020 / Accepted: 28 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Screw osteosynthesis using headless compression screws has become the accepted gold standard for the surgical treatment of scaphoid fractures. Optimal screw specifications remain controversially discussed. We aimed to investigate the influence of bone model composition on screw stability tests using headless compression screws in different scaphoid fracture models. We conducted pull-out tests using Acutrak2®mini, HCS®, HKS®, HBS®, Herbert/Whipple® and Twinfix® screws. To imitate cortical and cancellous bone, two-layer polyurethane (PU) models with two distinct densities were produced. The cylinders were cut at different positions to replicate fracture localisations at increasing distances. The maximum pull-out force required to achieve up to 1 mm of pull-out distance (Nto 1 mm) was measured. Acutrak2®mini and HCS® followed by Twinfix® showed the greatest average pull-out forces. Nto 1 mm was, on average, greater in the cortico-cancellous model than in the cancellous cylinder with the Acutrak2®mini and the Herbert/Whipple® screws, while it was the least with the HBS® and the Twinfix® screws; there were also differences between the HCS® and HKS®. There were no differences between the different fracture simulations in the synthesis strength using either the HKS® or HBS®. The pull-out forces of the HCS® and Twinfix® remained high also in simulations with the smaller screw base fragments. Varying imitations of cancellous and cortico-cancellous bone and fracture localisation reveal important information about the ex vivo strength of screw syntheses. The grip of the cortical structure should be used with the screws that fit more firmly in cortico-cancellous bone. Graphical Abstract
* Jochen Erhart [email protected] 1
2
Department of Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
3
Section of Medical Statistics at the Core Unit of Medical Statistics and Informatics, University of Vienna, Spitalgasse 23, A-1090 Wien, Austria
4
BG Clinic Tuebingen, Schnarrenbergstr. 95, D-72076 Tuebingen, Germany
92 Page 2 of 11
Journal of Materials Science: Materials in Medicine (2020)31:92
1 Introduction In the operative treatment of bone tissue in general, and particularly of scaphoid fractures, the blood supply to the fragments and the stability of the osteosynthesis determine the quality of fracture healing
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