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Knee Surgery, Sports Traumatology,... Apr 2013Although bioabsorbable screws promise to degrade within months up to several years after implantation, often this does not happen. In fact, other problems such as screw... (Review)
Review
PURPOSE
Although bioabsorbable screws promise to degrade within months up to several years after implantation, often this does not happen. In fact, other problems such as screw breakage, tunnel enlargement, allergic or foreign body reactions, cyst or abscess formation, and delayed migration of "biodegradable" screws have been reported. This study aims to provide relevant basic science knowledge and recent insights concerning "biomaterials" currently used in fixation devices for anterior cruciate ligament (ACL) repair. A systematic review on the topic of screw "migration" is provided.
METHODS
A PubMed search combining all the key terms was done looking for complications related to late migration of "bioabsorbable" screws used in ACL reconstruction without inferior time limitation up to January 2012. Only clinical reports were included. Reference lists of reports were checked to detect others not identified by the original search. A pre-publication search was performed to identify the most recent relevant articles.
RESULTS
A total of ten articles referred to migration of "bioabsorbable" interference screws. Most cases reported on poly-L-lactic acid-based screws. Migration was noticed between 3 and 22 months postoperatively. It was noticed both in the tibia and the femur and with the application of several types of graft.
CONCLUSION
Migration is a possible complication of "bioabsorbable" interference screws. The information related to all clinical implications of the so-called "biodegradable screws" remains scarce and probably suffers from the phenomenon of publication bias. The complexity of possible reactions occurring in the human body is difficult to reproduce under controlled laboratory conditions.
Topics: Absorbable Implants; Anterior Cruciate Ligament; Anterior Cruciate Ligament Reconstruction; Bone Screws; Foreign-Body Migration; Humans; Lactic Acid; Polyesters; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Polymers
PubMed: 23377842
DOI: 10.1007/s00167-013-2414-2 -
Journal of Indian Prosthodontic Society 2021To systematically review the reported techniques, for evaluating the risk and difficulty encountered in the management of fractured abutment screw in accordance with the... (Review)
Review
AIM
To systematically review the reported techniques, for evaluating the risk and difficulty encountered in the management of fractured abutment screw in accordance with the location of fracture, and to develop a logical sequence in managing an implant abutment screw fracture.
SETTINGS AND DESIGN
Systematic review following PRISMA guidelines.
MATERIALS AND METHODS
A systematic search of the PubMed/MEDLINE database for articles published between January 2000 and March 2020 was performed by 2 independent reviewers. Case reports and case series that described the management of fractured implant abutment screw were included. Published articles were qualitatively analyzed employing CARE guidelines and were classified according to the location of screw fracture with respect to implant platform, risk of damage to the implant, and intervention for managing the fractured screw.
STATISTICAL ANALYSIS USED
Qualitative analyisis.
RESULTS
A total of 28 articles were included in the review. Two of them explained the management of screw fracture at or above the implant platform and required only mild approach with low risk while the others explained the management of screw fracture below the level of implant platform. Among them, 6 were considered mild approach with low risk, 13 moderate approach with moderate risk, and 8 of them severe approach with high risk.
CONCLUSION
Irrespective of the technique, any attempt to retrieve abutment screw fragment poses some risk to the implant which is varying from mild to severe. As the location of fracture is more gingival to the implant platform, difficulty of retrieval as well as risk to the implant increases. The proposed decisionmaking tree will be a useful tool in helping clinicians to manage abutment screw fracture.
Topics: Bone Screws
PubMed: 34380809
DOI: 10.4103/jips.jips_295_20 -
Medical Science Monitor : International... Aug 2019The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both... (Review)
Review
The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Cervical Vertebrae; Humans; Neck; Neurosurgical Procedures; Orthopedic Procedures; Spine
PubMed: 31432800
DOI: 10.12659/MSM.918061 -
Orthopaedics & Traumatology, Surgery &... Dec 2022For large bone defects, after curettage of aggressive bone tumors; such as giant-cell tumors, cementation with supplement internal fixation was used to prevent...
BACKGROUND
For large bone defects, after curettage of aggressive bone tumors; such as giant-cell tumors, cementation with supplement internal fixation was used to prevent subsequent collapse of the cement-bone constructs. The purpose of this study is to compare the pull-out strength of cement augmented screws between inserting screws in the working phase or hard phase of bone cement.
HYPOTHESIS
Timing at which completed screw insertion takes place affecting the pull-out strength of cement augmented screws.
METHODS
Pull-out strength was compared between screws; inserted within the working phases of cement, and after the cement was hardened in high viscos cement blocks. Each group consists of 10 cortex screws, 10 cancellous screws and 10 locking screws. The pull-out strength test was followed using the instructions of ASTM F543-13e1 Standard Specification and Test Methods, for Metallic Medical Bone Screws.
RESULTS
Screws that were inserted in the working phases of cement had significantly higher pull-out strength, than those inserted in hard cement (p=0.021). The pull-out strength was statistically significant in difference among the types of screws (p<0.001), with locking screws having the highest pull-out strength. Furthermore, the pull-out strength of locking screws revealed no significant difference when either; inserted during the working or hardened phases of bone cement.
CONCLUSION
Insertion of screws during the working periods of PMMA cement had higher pull out strength compared to the hard phase of cement. Hence, we recommend performing internal fixation before cementation after curettage of aggressive bone tumors. However, if the surgeon prefers to pack the cement first, for the benefit of avoiding residual bone defects, we suggest using a locking plate system to achieve comparable pull-out strength.
LEVEL OF EVIDENCE
In-vitro study.
Topics: Humans; Bone Cements; Biomechanical Phenomena; Bone Screws; Fracture Fixation, Internal; Bone Plates
PubMed: 34537392
DOI: 10.1016/j.otsr.2021.103060 -
Scientific Reports Oct 2020The use of aftermarket computer-aided design/computer-assisted manufacturing (CAD/CAM) prosthesis components in dental implants has become popular. This study aimed to...
The use of aftermarket computer-aided design/computer-assisted manufacturing (CAD/CAM) prosthesis components in dental implants has become popular. This study aimed to (1) compare the accuracy of aftermarket CAD/CAM screws with that of original equipment manufacturer (OEM) abutment screws and (2) examine the biomechanical effects of different abutment screws used with zirconia abutment in an implant fixture by using three-dimensional finite element analysis (FEA). Significantly different measurements were obtained for the aftermarket CAD/CAM and OEM screws. The FEA results indicated that under the same loading condition, the maximum stress of the aftermarket CAD/CAM screws was 15.9% higher than that of the OEM screws. Moreover, the maximum stress position occurred in a wide section of the OEM screws but in the narrowest section of the aftermarket screws. The stress of the OEM zirconia abutment was 14.9% higher when using the aftermarket screws than when using the OEM screws. The effect of the manufacturing differences between aftermarket and OEM screws on the clinical effect of aftermarket screws is unpredictable. Therefore, aftermarket screws should be cautiously used clinically.
Topics: Biomechanical Phenomena; Bone Screws; Computer-Aided Design; Dental Abutments; Dental Implants; Finite Element Analysis; Zirconium
PubMed: 33110137
DOI: 10.1038/s41598-020-75469-9 -
International Journal of Environmental... May 2021We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After...
We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.
Topics: Adult; Bone Screws; Hallux Valgus; Humans; Iatrogenic Disease; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 34070270
DOI: 10.3390/ijerph18115620 -
Archives of Orthopaedic and Trauma... Aug 2023Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the need to remove the screws on a systematic basis. The aim of this study was to determine (1) the proportion of screws removed after AA and (2) whether predictors of screw removal could be identified.
METHODS
This PRISMA-compliant systematic review was part of a larger previous protocol registered on the PROSPERO platform. Multiple databases were searched including studies in which patients undergone AA using screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).
RESULTS
Forty-four series of patients from thirty-eight studies (1990 ankles, 1934 patients) were selected. The average follow-up was 40.8 months (range 12-110). In all studies, hardware was removed due to symptoms reported by patients and related to the screws. The pooled proportion of removal of metalwork was 3% (95% CI 2-4). The pooled proportion of fusion was 96% (95%CI 95-98), while the pooled proportion of complications and reoperations (excluding the removal of metalwork) stood at 15% (95% CI 11-18) and 3% (95% CI 2-4), respectively. The mean mCMS (50.8 ± 8.1, range 35-66) revealed only an overall fair quality of studies. The univariate analysis and the multivariate model showed that the year of publication (R = - 0.004; p = 0.01) and the number of screws (R = 0.08; p = 0.01) were associated with the screw removal rate. Specifically, we found that over time the removal rate decreased by 0.4% per year and that the use of three screws instead of two reduced the risk of removal of metalwork by 8%.
CONCLUSIONS
In this review, removal of metalwork after ankle arthrodesis using cannulated screws was needed in 3% of cases at an average follow-up of 40.8 months. It was indicated only in case of symptoms related to soft tissue irritation from screws. The use of three screws was paradoxically related to a reduced risk of removal of screws as compared to two-screw constructs.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV.
Topics: Humans; Ankle; Ankle Joint; Bone Screws; Arthrodesis; Retrospective Studies
PubMed: 36795152
DOI: 10.1007/s00402-023-04813-1 -
Scientific Reports Jun 2022Screw loosening is one of the most common clinical problems of dental implants. Research on the influencing factors of screw loosening is very important to prevent screw...
Screw loosening is one of the most common clinical problems of dental implants. Research on the influencing factors of screw loosening is very important to prevent screw loosening. The purpose of this in vitro study was to evaluate the influence of liquid contamination on the screw loosening. According to the contamination condition, forty-five abutment screws were divided into three groups (n = 15): no contamination, artificial saliva contamination, and mouthwash contamination. The preload and friction coefficient of the abutment screws were recorded. Then, the reverse torque values (RTVs) and settlement were measured after 3.0 × 10 and 6.0 × 10 cycles. The surface wear of the screws was analyzed. Finally, the stress distribution of the abutment screws was calculated by finite element analysis (FEA). The results showed that fluid contamination reduced the friction coefficient, increased the preload, decrease the settlement, improved resistance to screw loosening, and reduced wear on the thread surface. Appropriate antimicrobial lubrication may improve the anti-loosening performance of abutment screws and prevent excessive wear on the threaded surface.
Topics: Bone Screws; Dental Implants; Finite Element Analysis; Friction; Lubrication; Torque
PubMed: 35750776
DOI: 10.1038/s41598-022-14791-w -
Fertility and Sterility Dec 2020
Topics: Bone Screws; Female; Fertilization; Fertilization in Vitro; Humans; Intergenerational Relations; Pregnancy
PubMed: 32873372
DOI: 10.1016/j.fertnstert.2020.08.008 -
PloS One 2015Nanosized iron oxide particles exhibit osteogenic and radiopaque properties. Thus, iron oxide (Fe3O4) nanoparticles were incorporated into a biodegradable polymer...
Nanosized iron oxide particles exhibit osteogenic and radiopaque properties. Thus, iron oxide (Fe3O4) nanoparticles were incorporated into a biodegradable polymer (poly-L-lactic acid, PLLA) to fabricate a composite bone screw. This multifunctional, 3D printable bone screw was detectable on X-ray examination. In this study, mechanical tests including three-point bending and ultimate tensile strength were conducted to evaluate the optimal ratio of iron oxide nanoparticles in the PLLA composite. Both injection molding and 3D printing techniques were used to fabricate the PLLA bone screws with and without the iron oxide nanoparticles. The fabricated screws were implanted into the femoral condyles of New Zealand White rabbits. Bone blocks containing the PLLA screws were resected 2 and 4 weeks after surgery. Histologic examination of the surrounding bone and the radiopacity of the iron-oxide-containing PLLA screws were evaluated. Our results indicated that addition of iron oxide nanoparticles at 30% significantly decreased the ultimate tensile stress properties of the PLLA screws. The screws with 20% iron oxide exhibited strong radiopacity compared to the screws fabricated without the iron oxide nanoparticles. Four weeks after surgery, the average bone volume of the iron oxide PLLA composite screws was significantly greater than that of PLLA screws without iron oxide. These findings suggested that biodegradable and X-ray detectable PLLA bone screws can be produced by incorporation of 20% iron oxide nanoparticles. Furthermore, these screws had significantly greater osteogenic capability than the PLLA screws without iron oxide.
Topics: Animals; Bone Screws; Femur; Ferric Compounds; Lactic Acid; Nanoparticles; Osteogenesis; Polyesters; Polymers; Printing, Three-Dimensional; Rabbits; Radiography; Tensile Strength; X-Rays
PubMed: 26466309
DOI: 10.1371/journal.pone.0140354