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Screw insertion in trabecular bone causes peri-implant bone damage.

Juri A Steiner1, Stephen J Ferguson1, G Harry van Lenthe2

  • 1Institute for Biomechanics, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland.

Medical Engineering & Physics
|February 28, 2016
PubMed
Summary

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Screw insertion causes bone damage, especially in osteoporotic bone. Larger screws cause more damage at greater distances, impacting implant stability and requiring consideration in surgical planning and modeling.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Engineering
  • Skeletal Biology

Background:

  • Secure fracture fixation is challenging, particularly in osteoporotic bone.
  • Existing research often overlooks bone damage from screw insertion itself, focusing instead on post-insertion loading effects.

Purpose of the Study:

  • To localize and quantify peri-implant bone damage resulting from the screw insertion process.
  • To compare bone damage caused by small thread size screws (STS) versus large thread size screws (LTS).

Main Methods:

  • Utilized non-invasive three-dimensional micro-computed tomography (micro-CT) to scan human femoral bone cores.
  • Registered pre- and post-screw insertion scans to identify and quantify micro-architectural changes.
  • Analyzed bone damage at radial distances of 0.3mm, 0.6mm, and 0.9mm for both STS and LTS groups.
Keywords:
image registrationorthopedicperi-implant damagescrew insertionμCT

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Main Results:

  • Most bone damage was concentrated within a 0.3mm radial distance of the screws.
  • Significant bone damage extended further for LTS (up to 0.9mm) compared to STS (up to 0.6mm).
  • The LTS group exhibited significantly more bone damage in regions between 0.3-0.6mm and 0.6-0.9mm radial distances than the STS group.

Conclusions:

  • This study is the first to non-invasively localize and quantify screw insertion-induced peri-implant bone damage using 3D micro-CT.
  • Peri-implant bone damage occurs during screw insertion, a critical factor for primary implant stability, especially in osteoporotic bone.
  • The developed micro-CT technique offers a promising method for systematically assessing bone damage, and incorporating this damage into in silico models can enhance accuracy.