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A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
Published on: January 6, 2023
Surgeon perception of cancellous screw fixation
Michael J Stoesz1, Peter A Gustafson, Bipinchandra V Patel
1*Department of Orthopaedic Surgery, Western Michigan University School of Medicine, Kalamazoo, MI; and †Department of Mechanical and Aeronautical Engineering, Western Michigan University, Kalamazoo, MI.
Journal of Orthopaedic Trauma
|June 21, 2013
Summary
Surgeons frequently stripped screws during synthetic bone fixation, often failing to recognize it. Improved surgical techniques are needed to ensure screw fixation stability in cancellous bone.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Surgical materials science
Background:
- Optimizing screw insertion torque is crucial for nonlocking fixation stability, especially in osteoporotic and cancellous bone.
- Surgeons' ability to control insertion torque impacts construct integrity.
- Screw stripping compromises fixation strength and can lead to construct failure.
Purpose of the Study:
- To evaluate screw torque applied by surgeons during synthetic cancellous bone fixation.
- To determine the frequency of screw stripping by surgeons.
- To identify factors associated with screw stripping and surgeons' ability to recognize it.
Main Methods:
- Ten surgeons performed screw and plate fixation on synthetic cancellous bone of varying densities.
- Screw insertion torque and axial force were measured.
- Surgeons' subjective assessment of screw stripping was compared to objective measurements.
Main Results:
- Surgeons stripped 45.4% of screws, failing to recognize stripping in 90.8% of cases.
- Screw stripping tendency varied significantly among surgeons but did not correlate with bone density or surgeon experience level.
- Stripped screws recognized by surgeons retained significantly less torque (55.0%) than unrecognized stripped screws (79.6%).
Conclusions:
- Surgeon perception is unreliable for preventing and detecting screw stripping at clinical torque levels in synthetic cancellous bone.
- Standardized insertion methods or less aggressive techniques may enhance the stability of nonlocking screw and plate constructs.
- Further research into surgeon training and objective feedback mechanisms is warranted.
