TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws

James Fletcher, Verena Neumann, Vasiliki Panagiotopoulou, Abigail Verschueren, Boyko Gueorguiev, R. Geoff Richards, Michael Whitehouse, Ezio Preatoni, Richie Gill

Research output: Contribution to conferencePaper

Abstract

Objectives: Non-locking screws remain one of the most commonly used orthopaedic implants, however they are often poorly inserted. Exceeding the stripping torque for a screw hole reduces pullout strength. The aims of this study were firstly to quantify stripping rates and screw tightness for surgeons and secondly to assess how these change when using a screwdriver that indicates when optimum tightness is reached. Methods: At the AO Davos Courses 2018 (Davos, Switzerland), 302 orthopaedic surgeons tightened 20 screws in two phases: Phase 1 - screws tightened to the surgeon’s perception of optimum tightness. Phase 2 - using an augmented screwdriver that indicated, by audibly alarming and vibrating, when a predetermined optimum tightness was reached (defined as 70% of the maximum stripping torque). Within each phase, 10 partially inserted 3.5 mm non-locking cortical screws were tightened through a 3.5 mm plate into 4 mm thick artificial bone analogue of 0.32 g/cm3. The stopping torque for each screw was recorded and compared to the stripping torque; if the stopping torque greatly exceeded the stripping torque, tightness values >100% were possible. A confidence value in each screw’s purchase was recorded, 1-10. Following tests of normality, Student t-tests were performed to compare different phases and insertion confidences. Results: For phases 1 and 2 respectively, stripping rates were 58 ±32% and 15 ±25% (p<0.0001) and the tightness for all screws was 190% ±255% (n=3020) and 87 ±49% (n=3020) (p<0.0001). Considering only unstripped insertions, tightness was 81 ±12% (n=1242) and 71 ±12% (n=2579) respectively. In phase 1, confidence was 7 ±2 (out of 10) for screws found to have not unstripped and 6 ±2 for stripped insertions (p=0.441), and 7 ±2 and 7 ±2 (p=0.216) in phase 2 respectively. Conclusion: With an unaugmented screwdriver (Phase 1), stripping rates were high, though varied greatly amongst surgeons. Using an augmented screwdriver (Phase 2) greatly improved insertion, with optimum tightness being achieving alongside a significantly reduced rate of bone stripping. Further work incorporating these techniques into surgical education and clinical practice are recommended.
Original languageEnglish
Publication statusPublished - Sep 2019
EventBone Research Society and British Orthopaedic Research Society 5th Joint Meeting - Sir Martin Evans Building, School of Biosciences, Cardiff University, Cardiff, UK United Kingdom
Duration: 4 Sep 20196 Sep 2019
https://boneresearchsociety.org/meeting/cardiff2019/

Conference

ConferenceBone Research Society and British Orthopaedic Research Society 5th Joint Meeting
Abbreviated titleBRS/BORS 5th Joint Meeting
CountryUK United Kingdom
CityCardiff
Period4/09/196/09/19
Internet address

Cite this

Fletcher, J., Neumann, V., Panagiotopoulou, V., Verschueren, A., Gueorguiev, B., Richards, R. G., ... Gill, R. (2019). TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws. Paper presented at Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff, UK United Kingdom.

TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws. / Fletcher, James; Neumann, Verena; Panagiotopoulou, Vasiliki; Verschueren, Abigail; Gueorguiev, Boyko; Richards, R. Geoff; Whitehouse, Michael; Preatoni, Ezio; Gill, Richie.

2019. Paper presented at Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff, UK United Kingdom.

Research output: Contribution to conferencePaper

Fletcher, J, Neumann, V, Panagiotopoulou, V, Verschueren, A, Gueorguiev, B, Richards, RG, Whitehouse, M, Preatoni, E & Gill, R 2019, 'TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws' Paper presented at Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff, UK United Kingdom, 4/09/19 - 6/09/19, .
Fletcher J, Neumann V, Panagiotopoulou V, Verschueren A, Gueorguiev B, Richards RG et al. TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws. 2019. Paper presented at Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff, UK United Kingdom.
Fletcher, James ; Neumann, Verena ; Panagiotopoulou, Vasiliki ; Verschueren, Abigail ; Gueorguiev, Boyko ; Richards, R. Geoff ; Whitehouse, Michael ; Preatoni, Ezio ; Gill, Richie. / TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws. Paper presented at Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff, UK United Kingdom.
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title = "TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws",
abstract = "Objectives: Non-locking screws remain one of the most commonly used orthopaedic implants, however they are often poorly inserted. Exceeding the stripping torque for a screw hole reduces pullout strength. The aims of this study were firstly to quantify stripping rates and screw tightness for surgeons and secondly to assess how these change when using a screwdriver that indicates when optimum tightness is reached. Methods: At the AO Davos Courses 2018 (Davos, Switzerland), 302 orthopaedic surgeons tightened 20 screws in two phases: Phase 1 - screws tightened to the surgeon’s perception of optimum tightness. Phase 2 - using an augmented screwdriver that indicated, by audibly alarming and vibrating, when a predetermined optimum tightness was reached (defined as 70{\%} of the maximum stripping torque). Within each phase, 10 partially inserted 3.5 mm non-locking cortical screws were tightened through a 3.5 mm plate into 4 mm thick artificial bone analogue of 0.32 g/cm3. The stopping torque for each screw was recorded and compared to the stripping torque; if the stopping torque greatly exceeded the stripping torque, tightness values >100{\%} were possible. A confidence value in each screw’s purchase was recorded, 1-10. Following tests of normality, Student t-tests were performed to compare different phases and insertion confidences. Results: For phases 1 and 2 respectively, stripping rates were 58 ±32{\%} and 15 ±25{\%} (p<0.0001) and the tightness for all screws was 190{\%} ±255{\%} (n=3020) and 87 ±49{\%} (n=3020) (p<0.0001). Considering only unstripped insertions, tightness was 81 ±12{\%} (n=1242) and 71 ±12{\%} (n=2579) respectively. In phase 1, confidence was 7 ±2 (out of 10) for screws found to have not unstripped and 6 ±2 for stripped insertions (p=0.441), and 7 ±2 and 7 ±2 (p=0.216) in phase 2 respectively. Conclusion: With an unaugmented screwdriver (Phase 1), stripping rates were high, though varied greatly amongst surgeons. Using an augmented screwdriver (Phase 2) greatly improved insertion, with optimum tightness being achieving alongside a significantly reduced rate of bone stripping. Further work incorporating these techniques into surgical education and clinical practice are recommended.",
author = "James Fletcher and Verena Neumann and Vasiliki Panagiotopoulou and Abigail Verschueren and Boyko Gueorguiev and Richards, {R. Geoff} and Michael Whitehouse and Ezio Preatoni and Richie Gill",
note = "Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff (UK), 4-6 Sep 2019; Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, BRS/BORS 5th Joint Meeting ; Conference date: 04-09-2019 Through 06-09-2019",
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T1 - TightRight : augmenting screwdrivers to reduce bone stripping rates and optimise tightness when inserting non-locking screws

AU - Fletcher, James

AU - Neumann, Verena

AU - Panagiotopoulou, Vasiliki

AU - Verschueren, Abigail

AU - Gueorguiev, Boyko

AU - Richards, R. Geoff

AU - Whitehouse, Michael

AU - Preatoni, Ezio

AU - Gill, Richie

N1 - Bone Research Society and British Orthopaedic Research Society 5th Joint Meeting, Cardiff (UK), 4-6 Sep 2019

PY - 2019/9

Y1 - 2019/9

N2 - Objectives: Non-locking screws remain one of the most commonly used orthopaedic implants, however they are often poorly inserted. Exceeding the stripping torque for a screw hole reduces pullout strength. The aims of this study were firstly to quantify stripping rates and screw tightness for surgeons and secondly to assess how these change when using a screwdriver that indicates when optimum tightness is reached. Methods: At the AO Davos Courses 2018 (Davos, Switzerland), 302 orthopaedic surgeons tightened 20 screws in two phases: Phase 1 - screws tightened to the surgeon’s perception of optimum tightness. Phase 2 - using an augmented screwdriver that indicated, by audibly alarming and vibrating, when a predetermined optimum tightness was reached (defined as 70% of the maximum stripping torque). Within each phase, 10 partially inserted 3.5 mm non-locking cortical screws were tightened through a 3.5 mm plate into 4 mm thick artificial bone analogue of 0.32 g/cm3. The stopping torque for each screw was recorded and compared to the stripping torque; if the stopping torque greatly exceeded the stripping torque, tightness values >100% were possible. A confidence value in each screw’s purchase was recorded, 1-10. Following tests of normality, Student t-tests were performed to compare different phases and insertion confidences. Results: For phases 1 and 2 respectively, stripping rates were 58 ±32% and 15 ±25% (p<0.0001) and the tightness for all screws was 190% ±255% (n=3020) and 87 ±49% (n=3020) (p<0.0001). Considering only unstripped insertions, tightness was 81 ±12% (n=1242) and 71 ±12% (n=2579) respectively. In phase 1, confidence was 7 ±2 (out of 10) for screws found to have not unstripped and 6 ±2 for stripped insertions (p=0.441), and 7 ±2 and 7 ±2 (p=0.216) in phase 2 respectively. Conclusion: With an unaugmented screwdriver (Phase 1), stripping rates were high, though varied greatly amongst surgeons. Using an augmented screwdriver (Phase 2) greatly improved insertion, with optimum tightness being achieving alongside a significantly reduced rate of bone stripping. Further work incorporating these techniques into surgical education and clinical practice are recommended.

AB - Objectives: Non-locking screws remain one of the most commonly used orthopaedic implants, however they are often poorly inserted. Exceeding the stripping torque for a screw hole reduces pullout strength. The aims of this study were firstly to quantify stripping rates and screw tightness for surgeons and secondly to assess how these change when using a screwdriver that indicates when optimum tightness is reached. Methods: At the AO Davos Courses 2018 (Davos, Switzerland), 302 orthopaedic surgeons tightened 20 screws in two phases: Phase 1 - screws tightened to the surgeon’s perception of optimum tightness. Phase 2 - using an augmented screwdriver that indicated, by audibly alarming and vibrating, when a predetermined optimum tightness was reached (defined as 70% of the maximum stripping torque). Within each phase, 10 partially inserted 3.5 mm non-locking cortical screws were tightened through a 3.5 mm plate into 4 mm thick artificial bone analogue of 0.32 g/cm3. The stopping torque for each screw was recorded and compared to the stripping torque; if the stopping torque greatly exceeded the stripping torque, tightness values >100% were possible. A confidence value in each screw’s purchase was recorded, 1-10. Following tests of normality, Student t-tests were performed to compare different phases and insertion confidences. Results: For phases 1 and 2 respectively, stripping rates were 58 ±32% and 15 ±25% (p<0.0001) and the tightness for all screws was 190% ±255% (n=3020) and 87 ±49% (n=3020) (p<0.0001). Considering only unstripped insertions, tightness was 81 ±12% (n=1242) and 71 ±12% (n=2579) respectively. In phase 1, confidence was 7 ±2 (out of 10) for screws found to have not unstripped and 6 ±2 for stripped insertions (p=0.441), and 7 ±2 and 7 ±2 (p=0.216) in phase 2 respectively. Conclusion: With an unaugmented screwdriver (Phase 1), stripping rates were high, though varied greatly amongst surgeons. Using an augmented screwdriver (Phase 2) greatly improved insertion, with optimum tightness being achieving alongside a significantly reduced rate of bone stripping. Further work incorporating these techniques into surgical education and clinical practice are recommended.

M3 - Paper

ER -