Influence of thread design on anchorage of pedicle screws in cancellous bone: an experimental and analytical analysis.

Threads of modern pedicle screws can vary greatly in design. It is difficult to assess which interplay of design features is particularly advantageous for screw anchorage. This study aims to increase the understanding of the anchorage behaviour between screw and cancellous bone. Pull-out tests of six pedicle screws in two sizes each were performed on three densities of biomechanical test material. More general screw characteristics were derived from the screw design and evaluated using the test data. Selected screws were tested on body donor material. Some screw characteristics, such as compacting, are well suited to compare the different thread designs of screws with tapered core. The combination of two characteristics, one representing bone compacting and one representing thread flank area, appears to be particularly advantageous for assessing anchorage behaviour. With an equation derived from these characteristics, the pull-out strength could be calculated very accurately (mean deviation 1%). Furthermore, findings are corroborated by tests on donor material. For screws with tapered core, the design demands for good anchorage against pull-out from cancellous bone change with material density. With sufficient bone quality, screws with a high compacting effect are advantageous, while with low bone density a high thread flank area also appears necessary for better screw anchorage.

Numerical Flow Simulation on the Virus Spread of SARS-CoV-2 Due to Airborne Transmission in a Classroom.

In order to continue using highly frequented rooms such as classrooms, seminar rooms, offices, etc., any SARS-CoV-2 virus concentration that may be present must be kept low or reduced through suitable ventilation measures. In this work, computational fluid dynamics (CFD) is used to develop a virtual simulation model for calculating and analysing the viral load due to airborne transmission in indoor environments aiming to provide a temporally and spatially-resolved risk assessment with explicit relation to the infectivity of SARS-CoV-2. In this work, the first results of the model and method are presented. In particular, the work focuses on a critical area of the education infrastructure that has suffered severely from the pandemic: classrooms. In two representative classroom scenarios (teaching and examination), the duration of stay for low risk of infection is investigated at different positions in the rooms for the case that one infectious person is present. The results qualitatively agree well with a documented outbreak in an elementary school but also show, in comparisons with other published data, how sensitive the assessment of the infection risk is to the amount of virus emitted on the individual amount of virus required for infection, as well as on the supply air volume. In this regard, the developed simulation model can be used as a useful virtual assessment for a detailed seat-related overview of the risk of infection, which is a significant advantage over established analytical models.

Recommendations for standardised screw pull-out from polyurethane foam - The influence of density variations of the test foam and the insertion method.

Insertion and pull-out tests of synthetic test material are well established for the initial laboratory evaluation of screws. However, not all test parameters are sufficiently described. The influence of small density deviations of the test material, of tapping or of manual or machine insertion has not been fully examined. The aim of the present study was to examine the influence of these specimen preparation parameters on the measurement results in order to increase the reproducibility and reliability of screw pull-out tests. For this purpose, a commercial polyurethane foam and a clinically used type of screw are evaluated with insertion and pull-out tests. Within a foam apparent density grade, small deviations in apparent density led to significant and relevant differences in the measured values of insertion torque and pull-out strength. Furthermore, an influence on the measurement results was found during tapping and during manual or machine insertion of screws. For these reasons, specimens with the same apparent density should be used as far as possible and evenly distributed among the test groups. In addition, the reproducibility of the results can be increased by machine insertion of the screws.

Determination of anisotropic elastic parameters from morphological parameters of cancellous bone for osteoporotic lumbar spine.

In biomechanics, large finite element models with macroscopic representation of several bones or joints are necessary to analyze implant failure mechanisms. In order to handle large simulation models of human bone, it is crucial to homogenize the trabecular structure regarding the mechanical behavior without losing information about the realistic material properties. Accordingly, morphology and fabric measurements of 60 vertebral cancellous bone samples from three osteoporotic lumbar spines were performed on the basis of X-ray microtomography (µCT) images to determine anisotropic elastic parameters as a function of bone density in the area of pedicle screw anchorage. The fabric tensor was mapped in cubic bone volumes by a 3D mean-intercept-length method. Fabric measurements resulted in a high degree of anisotropy (DA = 0.554). For the Young's and shear moduli as a function of bone volume fraction (BV/TV, bone volume/total volume), an individually fit function was determined and high correlations were found (97.3 ≤ R2 ≤ 99.1,p < 0.005). The results suggest that the mathematical formulation for the relationship between anisotropic elastic constants and BV/TV is applicable to current µCT data of cancellous bone in the osteoporotic lumbar spine. In combination with the obtained results and findings, the developed routine allows determination of elastic constants of osteoporotic lumbar spine. Based on this, the elastic constants determined using homogenization theory can enable efficient investigation of human bone using finite element analysis (FEA). Graphical Abstract Cancellous Bone with Fabric Tensor Ellipsoid representing anisotropy and principal axis (colored coordinate system) of given trabecular structure.

A novel parameter for the prediction of pedicle screw fixation in cancellous bone - A biomechanical study on synthetic foam.

Pedicle screw loosening is still observed in clinical practice. Therefore, the understanding of the interaction between screw and bone is evermore subject of research. However, complex relationships between screw design and anchorage are rarely examined. For this reason, it is investigated whether screw fixation is predictable by a parameter that maps the thread. Two types of pedicle screws, 6.5 mm and 7.5 mm in major diameter, respectively, are pulled out from synthetic polyurethane foam. Representative design parameters were evaluated with regard to their influence on the insertion torque and pull-out strength. A correlation between the insertion torque and the degree of compacting of the bone was observed. In addition, the pull-out strength was found to be related to the contact area of the bone-screw interface, the bone volume displaced during screwing, and the displaced diameter. The relationship between insertion torque and pull-out strength was also linear. In addition, a relational equation was derived for the pull-out strength versus the insertion torque with the major diameter as scaling factor. Thus, the pull-out strength from cancellous bone is predictable by a representative design parameter. Furthermore, the derived relation equation opens a new perspective for the evaluation of screw fixation.