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Mechanical Testing of Epiphysiodesis Screws.

Brett M Normandin, David J Tennent, Todd H Baldini

    Orthopedics
    |January 30, 2018
    PubMed
    Summary

    Noncannulated, partially threaded screws are less stiff but stronger than cannulated screws for pediatric epiphysiodesis, reducing the risk of screw failure during growth modulation.

    Area of Science:

    • Orthopedic Surgery
    • Biomechanical Engineering
    • Pediatric Orthopedics

    Background:

    • Epiphysiodesis is a surgical procedure to correct limb length discrepancies and angular deformities in children.
    • Growth modulation implants, such as screws, can experience mechanical failure (bending or breaking) when placed across the physis.
    • Understanding the mechanical properties of different screw designs is crucial for optimizing surgical outcomes.

    Purpose of the Study:

    • To evaluate and compare the mechanical properties (stiffness and ultimate load) of three commonly used screw designs for pediatric epiphysiodesis.
    • To determine which screw design offers superior mechanical integrity under simulated physiological conditions.
    • To provide evidence-based guidance for orthopedic surgeons selecting implants for growth modulation procedures.

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    Main Methods:

    • Mechanical testing (cantilever bending and tension) was performed on three types of 4.0-mm cancellous screws: fully threaded cannulated, partially threaded cannulated, and partially threaded noncannulated.
    • Screws were tested in simulated cancellous bone foam blocks to mimic in vivo conditions.
    • A servo-hydraulic testing machine was used to measure stiffness and ultimate load to failure, with statistical analysis (ANOVA and Tukey's test) to compare groups (P<.05).

    Main Results:

    • Noncannulated, partially threaded screws exhibited significantly lower stiffness compared to both cannulated screw types in both tension and bending tests (P<.001).
    • Noncannulated, partially threaded screws demonstrated a significantly higher ultimate load to failure than cannulated screws in tension (P<.001) and cannulated, partially threaded screws in bending (P=.045).
    • The results indicate distinct mechanical behaviors among the tested screw designs.

    Conclusions:

    • Noncannulated, partially threaded screws possess greater ultimate load capacity and are less stiff than cannulated screw designs.
    • These findings suggest that noncannulated, partially threaded screws may be less prone to mechanical failure after epiphysiodesis.
    • Surgeons should consider these mechanical differences when selecting screws for pediatric growth modulation to enhance implant durability and surgical success.