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Dynamic locking screw improves fixation strength in osteoporotic bone: an in vitro study on an artificial bone model

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Abstract

Purpose

The novel dynamic locking screw (DLS) was developed to improve bone healing with locked-plate osteosynthesis by equalising construct stiffness at both cortices. Due to a theoretical damping effect, this modulated stiffness could be beneficial for fracture fixation in osteoporotic bone. Therefore, the mechanical behaviour of the DLS at the screw–bone interface was investigated in an artificial osteoporotic bone model and compared with conventional locking screws (LHS).

Methods

Osteoporotic surrogate bones were plated with either a DLS or a LHS construct consisting of two screws and cyclically axially loaded (8,500 cycles, amplitude 420 N, increase 2 mN/cycle). Construct stiffness, relative movement, axial screw migration, proximal (P) and distal (D) screw pullout force and loosening at the bone interface were determined and statistically evaluated.

Results

DLS constructs exhibited a higher screw pullout force of P 85 N [standard deviation (SD) 21] and D 93 N (SD 12) compared with LHS (P 62 N, SD 28, p = 0.1; D 57 N, SD 25, p < 0.01) and a significantly lower axial migration over cycles compared with LHS (p = 0.01). DLS constructs showed significantly lower axial construct stiffness (403 N/mm, SD 21, p < 0.01) and a significantly higher relative movement (1.1 mm, SD 0.05, p < 0.01) compared with LHS (529 N/mm, SD 27; 0.8 mm, SD 0.04).

Conclusion

Based on the model data, the DLS principle might also improve in vivo plate fixation in osteoporotic bone, providing enhanced residual holding strength and reducing screw cutout. The influence of pin-sleeve abutment still needs to be investigated.

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Acknowledgments

This investigation was performed with the assistance of the AO Foundation via the AOTK System. DePuy Synthes is acknowledged for the delivery of all implants.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Saarland, Saar, Germany

    Tim Pohlemann

  2. AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland

    Boyko Gueorguiev, Yash Agarwal, Dieter Wahl, Christoph Sprecher & Mark Lenz

  3. AO Foundation, TK System, Clavadelerstrasse 8, 7270, Davos, Switzerland

    Tim Pohlemann & Karsten Schwieger

  4. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany

    Mark Lenz

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  1. Tim Pohlemann
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  2. Boyko Gueorguiev
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  3. Yash Agarwal
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Corresponding author

Correspondence to Boyko Gueorguiev.

Additional information

Tim Pohlemann and Boyko Gueorguiev contributed equally to this study.

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Pohlemann, T., Gueorguiev, B., Agarwal, Y. et al. Dynamic locking screw improves fixation strength in osteoporotic bone: an in vitro study on an artificial bone model. International Orthopaedics (SICOT) 39, 761–768 (2015). https://doi.org/10.1007/s00264-014-2658-6

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  • DOI: https://doi.org/10.1007/s00264-014-2658-6

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