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A radiologic determination of the different screw cutting patterns in cut and uncut orthopedic cortical screws using a novel imaging technique

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Abstract

Objective

We hypothesize that cut screws will deform in a manner that increases the core and outer diameters of the screw hole compared to uncut controls, and effects will be more pronounced in titanium screws.

Materials and methods

We used biomechanical polyurethane foam blocks to simulate cortical bone. We organized four groups of stainless steel and titanium cut and uncut screws. Blocks were fitted with a jig to ensure perpendicular screw insertion. We imaged the blocks using digital mammography and measured them using PACS software. Power analysis determined a power of 0.95 and an alpha error of 0.05.

Results

Highly statistically significant differences in core diameter were found after cutting stainless steel and titanium screws. Cutting stainless steel screws increased core diameter by 0.30 mm (95% CI, 0.16 to 0.45; p < .001). Titanium screws’ core diameter increased by 0.45 mm (95% CI, 0.30 to 0.61; p < .001). No significant differences were found in the outer diameters of stainless steel and titanium screws after cutting.

Conclusion

Titanium and stainless steel screw tracts demonstrated screw core diameter and screw thread pattern deformation after cutting. Titanium screws demonstrated more significant effects.

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Funding

The authors utilized no outside sources of funding in the preparation or execution of this research. The senior author utilized personal funds to acquire all materials and research literature. The Simulation Center at Naval Medical Center Portsmouth loaned their Synthes® 3.5 mm small fragment locking tray and donated 26 3.5 mm stainless steel cortical screws and 20 3.5 mm titanium cortical screws for this study from their surplus stock.

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Authors and Affiliations

  1. Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA

    Joshua W. Major

  2. Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA

    Andrew J. Ernst, Jonathan K. Kallevang, Stephen D. Grijalva, Thomas J. Douglas & Conor B. Garry

  3. Department of Radiation Physics, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA

    Alexander Kaeck

  4. Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA

    Andrew W. Wilson & Conor B. Garry

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  1. Joshua W. Major
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  2. Andrew J. Ernst
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  3. Jonathan K. Kallevang
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Correspondence to Joshua W. Major.

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Major, J.W., Ernst, A.J., Kallevang, J.K. et al. A radiologic determination of the different screw cutting patterns in cut and uncut orthopedic cortical screws using a novel imaging technique. Skeletal Radiol 52, 2461–2467 (2023). https://doi.org/10.1007/s00256-023-04368-7

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  • DOI: https://doi.org/10.1007/s00256-023-04368-7

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