Automated Bone Screw Tightening to Adaptive Levels of Stripping Torque.

OBJECTIVE: To use relationships between tightening parameters, related to bone quality, to develop an automated system that determines and controls the level of screw tightening. METHODS: An algorithm relating current at head contact (IHC) to current at construct failure (Imax) was developed. The algorithm was used to trigger cessation of screw insertion at a predefined tightening level, in real time, between head contact and maximum current. The ability of the device to stop at the predefined level was assessed. RESULTS: The mean (±SD) current at which screw insertion ceased was calculated to be [51.47 ± 9.75% × (Imax - IHC)] + IHC, with no premature bone failures. CONCLUSIONS: A smart screwdriver was developed that uses the current from the motor driving the screw to predict the current at which the screw will strip the bone threads. The device was implemented and was able to achieve motor shut-off and cease tightening at a predefined threshold, with no premature bone failures.

Predicting cancellous bone failure during screw insertion.

Internal fixation of fractures often requires the tightening of bone screws to stabilise fragments. Inadequate application of torque can leave the fracture unstable, while over-tightening results in the stripping of the thread and loss of fixation. The optimal amount of screw torque is specific to each application and in practice is difficult to attain due to the wide variability in bone properties including bone density. The aim of the research presented in this paper is to investigate the relationships between motor torque and screw compression during powered screw insertion, and to evaluate whether the torque during insertion can be used to predict the ultimate failure torque of the bone. A custom test rig was designed and built for bone screw experiments. By inserting cancellous bone screws into synthetic, ovine and human bone specimens, it was established that variations related to bone density could be automatically detected through the effects of the bone on the rotational characteristics of the screw. The torque measured during screw insertion was found to be directly related to bone density and can be used, on its own, as a good predictor of ultimate failure torque of the bone.

A model for the change of cancellous bone volume and structure over time.

A model is presented for characterizing the process by which cancellous bone changes in volume and structure over time. The model comprises simulations of local changes resulting from individual remodelling events, known as bone multicellular units (BMU), and an ordinary differential equation for connecting the number of remodelling events to real time. The model is validated on micro-CT scans of tibiae of normal rats, estrogen deprived rats and estrogen deprived rats treated with bisphosphonates. The model explains the asymptotic trends seen in changes of bone volume over time resulting from estrogen deprivation as well as trends seen subsequent to treatment. The model demonstrates that both bone volume and structure changes can be explained in terms of resetting remodelling parameters. The model also shows that either current understanding of the effects of bisphosphonates is not correct or that the simplest description of remodelling does not suffice to explain both the change in bone volume and structure of rats treated with bisphosphonates.

Dietary salt, bone strength, and mineral content in unloaded rat femurs.

INTRODUCTION: Reduced bone mineral and ultimate strength are regular consequences of unloading bone. The aim of this study was to determine if high dietary salt intake would reduce the bone density and strength to a greater extent in rats with unloaded bones compared to ambulatory control rats fed the same dietary calcium and phosphorus. METHODS: Mature male Sprague-Dawley rats were divided into four groups: two exposed to a spaceflight model that unloaded the hind limbs (HU) and two controls (C) with normal ambulation. Half the HU and C rats were fed normal dietary salt (0.26%, NNa) and half high dietary salt (8%, HNa). The calcium (Ca) and phosphorus (P) content of the diets was normal (Ca 0.5% and P 0.6%) in all four groups. After 4 wk of hind limb unloading, the bone mineral content (BMC) of excised femurs was measured by the ash weight and the ultimate torsional strength was determined by a torsional strength test device. RESULTS: Femoral BMC (mg) was lower in HUNNa than C rats fed normal salt diets. Femurs from HU rats fed normal salt diets showed lower (20-26%) torsional strength (Nmm), compared to all other groups. DISCUSSION: It appears that high salt diets with normal amounts of calcium and phosphorus may prevent the decrease in bone torsional strength and BMC induced by unloading the femurs in 6-mo-old rats.

Regional bone mineral density in male athletes: a comparison of soccer players, runners and controls.

OBJECTIVES: To investigate the association of soccer playing and long-distance running with total and regional bone mineral density (BMD). DESIGN: Cross-sectional study. SETTING: Academic medical centre. PARTICIPANTS: Elite male soccer players (n = 15), elite male long-distance runners (n = 15) and sedentary male controls (n = 15) aged 20-30 years. MAIN OUTCOME MEASUREMENTS: BMD (g/cm2) of the lumbar spine (L1-L4), right hip, right leg and total body were assessed by dual-energy x-ray absorptiometry, and a scan of the right calcaneus was performed with a peripheral instantaneous x-ray imaging bone densitometer. RESULTS: After adjustment for age, weight and percentage body fat, soccer players had significantly higher whole body, spine, right hip, right leg and calcaneal BMD than controls (p = 0.008, p = 0.041, p<0.001, p = 0.019, p<0.001, respectively) and significantly higher right hip and spine BMD than runners (p = 0.012 and p = 0.009, respectively). Runners had higher calcaneal BMD than controls (p = 0.002). Forty percent of the runners had T-scores of the lumbar spine between -1 and -2.5. Controls were similar: 34% had T-scores below -1 (including 7% with T-scores lower than -2.5). CONCLUSIONS: Playing soccer is associated with higher BMD of the skeleton at all sites measured. Running is associated with higher BMD at directly loaded sites (the calcaneus) but not at relatively unloaded sites (the spine). Specific loading conditions, seen in ball sports or in running, play a pivotal role in skeletal adaptation. The importance of including an appropriate control group in clinical studies is underlined.

Effect of screw torque level on cortical bone pullout strength.

OBJECTIVES: The objectives of this study were 2-fold: (1) to perform detailed analysis of cortical screw tightening stiffness during automated insertion, and (2) to determine the effect of 3 torque levels on the holding strength of the bone surrounding the screw threads as assessed by screw pullout. METHODS: Ten pairs of ovine tibiae were used with 3 test sites spaced 20 mm apart centered along the shaft. One side of each pair was used for measuring ultimate failure torque (Tmax). These Tmax and bone-density values were used to predict Tmax at contralateral tibia sites. Screws were inserted and tightened to 50%, 70%, and 90% of predicted Tmax at the contralateral sites to encompass the average clinical level of torque (86% Tmax). Pullout tests were performed and maximum force values were normalized by cortical thickness. RESULTS: Torque to failure tests indicated tightening to 86% Tmax occurs after yield and leads to an average 51% loss in stiffness. Normalized pullout strength for screws tightened to 50% Tmax, 70% Tmax, and 90% Tmax were 2525 +/- 244, 2707 +/- 280, and 2344 +/- 346 N, respectively, with a significant difference between 70% Tmax and 90% Tmax groups (P < 0.05). CONCLUSIONS: Within the limitations of our study involving the testing of 1 type of screw purchase in ovine tibiae, results demonstrate that clinical levels of lag screw tightening (86% Tmax) are past the yield point of bone. Tightening to these high torque levels can cause damage leading to compromised holding strength. Further research is still required to establish the appropriate level of torque required for achieving optimal fracture fixation and healing.

Effect of activity and age on long bones using a new densitometric technique.

INTRODUCTION: Long bone structural parameters such as cross-sectional area or area moments of inertia are useful measures of long bone mechanical properties. We implemented a three-scan densitometric method to measure structural parameters in long bones of the lower leg in vivo. The validated method was applied to investigate the relationship between activity level, age, and long bone structural parameters in women. METHODS: An aluminum phantom was used to estimate in vivo setup accuracy. In vivo precision was determined by same-day repeated measures on human subjects. For the activity study, women were recruited in two age groups (25-35, 60+yr) and two activity levels (recreational runners, nonrunners). Scans were taken of the middle third of the lower right leg; structural parameters for the tibia and fibula were determined at each scan line, averaged over the section, and adjusted by factors accounting for body size variations. RESULTS: Aluminum phantom cross-sectional area was underestimated by 4-6%, principal moments were underestimated by <5%, and principal angles were within +/-1.2 degrees. In vivo precision results (lower energy, scans spanning 60 degrees) indicated coefficients of variation for cross-sectional area (A), principal moments of inertia (Imax, Imin), and polar moment of inertia (J) of 0.52, 5.87, 2.22, and 3.82%, respectively. The activity study showed mean adjusted tibial A, Imax, Imin, and J were significantly higher in runners compared with nonrunners. There was no dependence on age. CONCLUSIONS: A three-scan densitometric method for measuring cross-sectional structural parameters in long bones in vivo was validated; accuracy and precision measurements establishes confidence limits. From the activity study results, we postulate that higher loads associated with running lead to increased cross-sectional parameters to support axial loads, bending, and torsion in the tibia.

The response of Dahl salt-sensitive and salt-resistant female rats to a space flight model.

Vitamin D metabolism in the Dahl salt-sensitive (S) rat, a model of salt-induced hypertension, differs from that in the Dahl salt-resistant (R) rat. We have tested the hypothesis that differences in vitamin D metabolism would render the Dahl S rat more susceptible than the Dahl R rat to the effects of a space flight model. Dahl female rats were tail suspended (hind limb unloaded) for 28 days, while fed a low salt (3 g/kg sodium chloride) diet. Plasma 25-OHD concentrations of S rats were significantly lower than that of R rats. Plasma 1,25-(OH)2D concentration was 50% lower in unloaded than in loaded S rats, but was unaffected in unloaded R rats. The left soleus muscle weight and breaking strength of the left femur (torsion test) were 50% and 25% lower in unloaded than in loaded S and R rats. The mineral content of the left femur, however, was significantly lower (by 11%) only in unloaded S rats. We conclude that female S rats are more vulnerable than female R rats to decreases in plasma 1,25-(OH)2D concentration and femur mineral content during hind limb unloading, but equally vulnerable to muscle atrophy and reduced breaking strength of the femur.

Cross-sectional structural parameters from densitometry.

Bone densitometry has previously been used to obtain cross-sectional properties of bone from a single X-ray projection across the bone width. Using three unique projections, we have extended the method to obtain the principal area moments of inertia and orientations of the principal axes at each scan cross-section along the length of the scan. Various aluminum phantoms were used to examine scanner characteristics to develop the highest accuracy possible for in vitro non-invasive analysis of cross-sectional properties. Factors considered included X-ray photon energy, initial scan orientation, the angle spanned by the three scans (included angle), and I(min)/I(max) ratios. Principal moments of inertia were accurate to within +/-3.1% and principal angles were within +/-1 degrees of the expected value for phantoms scanned with included angles of 60 degrees and 90 degrees at the higher X-ray photon energy (140 kVp). Low standard deviations in the error (0.68-1.84%) also indicate high precision of calculated measurements with these included angles. Accuracy and precision decreased slightly when the included angle was reduced to 30 degrees. The method was then successfully applied to a pair of excised cadaveric tibiae. The accuracy and insensitivity of the algorithms to cross-sectional shape and changing isotropy (I(min)/I(max)) values when various included angles are used make this technique viable for future in vivo studies.