Local heat generation during screw insertion into diaphyseal bone: a biomechanical study on different conditions (e.g. screw type, material, mode of insertion)

BMC Musculoskeletal Disorders

Andre Frank¹  Berit Paul¹  Michael J. Raschke¹  Dirk Wähnert² 

[1] Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany;Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany;Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany;

关键词: Screw insertion;    Thermal necrosis;    Heat generation;    Screw material;    Screw design;    Insertion technique;   

DOI  :  10.1186/s12891-021-04723-6

来源: Springer

【 摘 要 】

BackgroundThe implantation of screws is a standard procedure in musculoskeletal surgery. Heat can induce thermal osteonecrosis, damage the bone and lead to secondary problems like implant loosening and secondary fractures. The aim of this study was to investigate whether screw insertion generates temperatures that can cause osteonecrosis.MethodsWe measured the temperature of twenty human femur diaphysis in a total of 120 measurements, while screws of different material (stainless steel and titanium alloy) and different design (locking and cortex screw) were inserted in three different screwing modes (manual vs. machine screwing at full and reduced rotational speed) with 6 thermocouples (3 cis and 3 trans cortex). Each was placed at a depth of 2 mm with a distance of 1.5 mm from the outer surface of the screw.ResultsThe screw design (cortical > locking), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (hand insertion > machine insertion) have an influence on the increase in bone temperature. The screw material (steel > titanium), the site of measurement (trans-cortex > cis-cortex) and the type of screw insertion (machine insertion > hand insertion) have an influence on the time needed to cool below critical temperature values. The combination of the two parameters (maximum temperature and cooling time), which is particularly critical for osteonecrosis, is found only at the trans-cortex.ConclusionInserting a screw hast the potential to increase the temperature of the surrounding bone tissue above critical values and therefore can induce osteonecrosis. The trans-cortex is the critical area for the development of temperatures above the osteonecrosis threshold, making effective cooling by irrigation difficult. It would be conceivable to cool the borehole with cold saline solution before inserting the screw or to cool the screw in cold saline solution. If possible, insertion by hand should be considered.

【 授权许可】

CC BY