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<a href="http://doi.org/10.1097/TA.0b013e31802bf051" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/TA.0b013e31802bf051</a>
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Pages
990-995
Issue
4
Volume
64
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Title
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The effect of pilot hole size on the insertion torque and pullout strength of self-tapping cortical bone screws in osteoporotic bone
Publisher
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Journal of Trauma-Injury Infection and Critical Care
Date
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2008
2008-04
Subject
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Surgery; osteoporosis; General & Internal Medicine; biomechanical testing; pilot; holding power; hole size; insertion torque; pullout strength; self-tapping cortical screws
Creator
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Battula S; Schoenfeld A J; Sahai V; Vrabec G A; Tank J; Njus G O
Description
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Background: All surgical screws can experience failure if the torsional, tensile, and flexion loads exerted on the screws are excessively high. The use of self-tapping screws (STS) results in higher insertion torques (IT) as these screws cut their own threads in the pilot hole drilled in the bone. In this study, the torque for inserting the STS into an osteoporotic bone block for different pilot hole sizes (PHS) was measured and the pullout strength (PS) for extraction of the screws was determined for different depths of insertion, 0 mm, 1 mm, and 2 mm beyond the far cortex. Methods: Seventy-two Synthes stainless steel STS (40 mm length and 3.5 mm diameter) were inserted into pilot holes of sizes 2.55 (A: 73% OD), 2.50 (B: 71.5%), 2.45 (C: 70 %), and 2.8 mm (D: 80 %). Using a digital torque screwdriver, screws were inserted to 0 mm, 1 mm or 2 mm past the far cortex. Pullout tests were conducted with an Instron materials testing system. Analysis of variance,and Student-Neuman-Keuls tests were performed to determine the effect of DOI and PHS on the loading energy, PS, and IT. Results: Results demonstrated that IT of the screws inserted into pilot holes A, B, and C were higher than those in D. It was also observed that PS and loading energy for 1 rum and 2 mm penetration past the far cortex were higher than those for 0 mm regardless of PHS. This study also found that an increase in PHS to 2.8 mm will reduce IT but will also reduce the PS relative to a PHS of 2.5 mm, the current standard for 3.5 mm screws. Conclusions: The results of previously published studies regarding the effect of pilot hole size on PS in healthy cortical bone cannot be applied to the osteoporotic environment. The findings presented in this research support using PHS no larger than 71.5% of the screw outer diameter (i.e., pilot hole size of 2.5 mm for 3.5 mm screws) and inserting screws at least 2 mm beyond the far cortex to maximize PS and minimize iatrogenic damage in osteoporotic bone.
Identifier
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<a href="http://doi.org/10.1097/TA.0b013e31802bf051" target="_blank" rel="noreferrer noopener">10.1097/TA.0b013e31802bf051</a>
Format
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Journal Article or Conference Abstract Publication
2008
Battula S
biomechanical testing
General & Internal Medicine
holding power
hole size
insertion torque
Journal Article or Conference Abstract Publication
Journal of Trauma-Injury Infection and Critical Care
Njus G O
Osteoporosis
pilot
pullout strength
Sahai V
Schoenfeld A J
self-tapping cortical screws
Surgery
Tank J
Vrabec G A