Non-locking screw insertion: No benefit seen if tightness exceeds 80% of the maximum torque

James W.A. Fletcher*, Beate Ehrhardt, Alisdair MacLeod, Michael R. Whitehouse, Harinderjit Gill, Ezio Preatoni

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
36 Downloads (Pure)

Abstract

Background: Millions of non-locking screws are manually tightened during surgery each year, but their insertion frequently results in overtightening and damage to the surrounding bone. We postulated that by calculating the torque limit of a screw hole, using bone and screw properties, the risk of overtightening during screw insertion could be reduced. Additionally, predicted maximum torque could be used to identify optimum screw torque, as a percentage of the maximum, based on applied compression and residual pullout strength. Methods: Longitudinal cross-sections were taken from juvenile bovine tibial diaphyses, a validated surrogate of human bone, and 3.5 mm cortical non-locking screws were inserted. Fifty-four samples were used to define the association between stripping torque and cortical thickness. The relationship derived enabled prediction of insertion torques representing 40 to 100% of the theoretical stripping torque (Tstr) for a further 170 samples. Screw-bone compression generated during insertion was measured, followed immediately by axial pullout testing. Findings: Screw-bone compression increased linearly with applied torque up to 80% of Tstr (R2 = 0.752, p < 0.001), but beyond this, no significant further compression was generated. After screw insertion, with all screw threads engaged, more tightening did not create any significant (R2 = 0.000, p = 0.498) increase in pullout strength. Interpretation: Increasing screw tightness beyond 80% of the maximum did not increase screw-bone compression. Variations in torques below Tstr, did not affect pullout forces of inserted screws. Further validation of these findings in human bone and creation of clinical guidelines based on this research approach should improve surgical outcomes and reduce operative costs.

Original languageEnglish
Pages (from-to)40-45
Number of pages6
JournalClinical Biomechanics
Volume70
Early online date9 Jul 2019
DOIs
Publication statusPublished - 1 Dec 2019

Structured keywords

  • Centre for Surgical Research

Keywords

  • Compression
  • Fixation failure
  • Insertion torque
  • Pullout force
  • Tightness

Fingerprint Dive into the research topics of 'Non-locking screw insertion: No benefit seen if tightness exceeds 80% of the maximum torque'. Together they form a unique fingerprint.

Cite this