How Pilot-hole Size Affects Bone-screw Pullout Strength in Human Cadaveric Cancellous Bone

Overview

Journal Can J Surg

Specialty General Surgery

Date 2005 Jul 15

PMID 16013624

Citations 5

Authors

Mark Steeves

Craig Stone

John Mogaard

Stephanie Byrne

Affiliations

Soon will be listed here.

Abstract

Objective: Screw failure of cancellous bone screws is not uncommon. To compare the effect of varying pilot-hole size on pullout strength of cancellous bone screws in human cadaveric bone, we designed and performed a biomechanical study to allow quantitative analysis.

Methods: Three pairs of distal femurs and 4 pairs of proximal tibias from embalmed human cadavers were stabilized in a mould, and the bone cortex was overdrilled. Four sites in a linear transverse plane were randomly assigned, anatomically matched with the paired bone and drilled with either pilot-hole size 3.2 mm or 2.5 mm. The cancellous screw (Synthes noncannulated 4.5-mm shaft, 6.5-mm external diameter) was guided into the pilot hole and pulled on by a test frame (Instron 8874 biaxial servo-hydraulic test frame) with increasing force to the point of failure, and the forces at which failure resulted were compared.

Results: A comparison of 25 anatomically paired sites with a 2-tailed paired t test and Wilcoxon matched-pairs signed rank test indicated significantly stronger pullout strength (p = 0.047 and p = 0.047) of the 2.5-mm compared with the 3.2-mm pilot hole. Subanalysis of the 4 studied locations indicated that 3 supported the above findings and 1 supported a reverse trend.

Conclusions: Generally, cancellous screws demonstrated a significantly (p < 0.05) stronger hold using a smaller size pilot hole than the recommended standard diameter. All locations except the inner lateral site supported this finding.

Citing Articles

Evaluation of the efficacy of modal analysis in predicting the pullout strength of fixation bone screws.

Einafshar M, Hashemi A, Kiapour A JOR Spine. 2023; 5(4):e1220.

PMID: 36601373 PMC: 9799086. DOI: 10.1002/jsp2.1220.

Salvaging Pull-Out Strength in a Previously Stripped Screw Site: A Comparison of Three Rescue Techniques.

Addevico F, Solitro G, Morandi M J Funct Morphol Kinesiol. 2021; 6(3).

PMID: 34564190 PMC: 8482251. DOI: 10.3390/jfmk6030071.

Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid.

Robo C, Wenner D, Ubhayasekera S, Hilborn J, Ohman-Magi C, Persson C J Funct Biomater. 2021; 12(1).

PMID: 33477310 PMC: 7839050. DOI: 10.3390/jfb12010005.

Kirschner wire prepared pilot holes improve screw pullout strength in synthetic osteoporotic-type bone.

Basmajian H, Liu J, Scudday T, Campbell S, Amin N J Clin Orthop Trauma. 2020; 11(Suppl 1):S100-S104.

PMID: 31992927 PMC: 6978199. DOI: 10.1016/j.jcot.2019.08.015.

Comparison and prediction of pullout strength of conical and cylindrical pedicle screws within synthetic bone.

Tsai W, Chen P, Lu T, Wu S, Shih K, Lin S BMC Musculoskelet Disord. 2009; 10:44.

PMID: 19402917 PMC: 2694760. DOI: 10.1186/1471-2474-10-44.

References

Lovick D, Ryken T, Traynelis V, Dexter F . Assessment of primary and salvage lateral mass screw insertion torque in a cadaveric model. J Spinal Disord. 1997; 10(5):431-5. View

Heller J, Estes B, Zaouali M, Diop A . Biomechanical study of screws in the lateral masses: variables affecting pull-out resistance. J Bone Joint Surg Am. 1996; 78(9):1315-21. DOI: 10.2106/00004623-199609000-00004. View

ALHO A . Mineral and mechanics of bone fragility fractures. A review of fixation methods. Acta Orthop Scand. 1993; 64(2):227-32. DOI: 10.3109/17453679308994578. View

Schatzker J, Horne J, Sumner-Smith G . The reaction of cortical bone to compression by screw threads. Clin Orthop Relat Res. 1975; (111):263-5. DOI: 10.1097/00003086-197509000-00033. View

Hughes A, Jordan B . The mechanical properties of surgical bone screws and some aspects of insertion practice. Injury. 1972; 4(1):25-38. DOI: 10.1016/s0020-1383(72)80007-x. View

Hearn T, Schatzker J, Wolfson N . Extraction strength of cannulated cancellous bone screws. J Orthop Trauma. 1993; 7(2):138-41. DOI: 10.1097/00005131-199304000-00006. View

George D, Krag M, Johnson C, Van Hal M, Haugh L, Grobler L . Hole preparation techniques for transpedicle screws. Effect on pull-out strength from human cadaveric vertebrae. Spine (Phila Pa 1976). 1991; 16(2):181-4. View

Sjostedt A, Zetterberg C, Hansson T, Hult E, Ekstrom L . Bone mineral content and fixation strength of femoral neck fractures. A cadaver study. Acta Orthop Scand. 1994; 65(2):161-5. DOI: 10.3109/17453679408995426. View

Cornell C . Internal fracture fixation in patients with osteoporosis. J Am Acad Orthop Surg. 2003; 11(2):109-19. DOI: 10.5435/00124635-200303000-00005. View

10.

Ding M, Dalstra M, Danielsen C, Kabel J, Hvid I, Linde F . Age variations in the properties of human tibial trabecular bone. J Bone Joint Surg Br. 1997; 79(6):995-1002. DOI: 10.1302/0301-620x.79b6.7538. View

11.

Heidemann W, Gerlach K, Grobel K, Kollner H . Influence of different pilot hole sizes on torque measurements and pullout analysis of osteosynthesis screws. J Craniomaxillofac Surg. 1998; 26(1):50-5. DOI: 10.1016/s1010-5182(98)80035-8. View

12.

Tsuji T, Kitano K, Yamano Y, Sato T, Koike T . Distribution of bone mineral density in the proximal tibia in mid-teens. J Bone Miner Metab. 2001; 19(5):324-8. DOI: 10.1007/s007740170019. View

13.

Chapman J, Harrington R, Lee K, Anderson P, Tencer A, Kowalski D . Factors affecting the pullout strength of cancellous bone screws. J Biomech Eng. 1996; 118(3):391-8. DOI: 10.1115/1.2796022. View

14.

Daftari T, Horton W, Hutton W . Correlations between screw hole preparation, torque of insertion, and pullout strength for spinal screws. J Spinal Disord. 1994; 7(2):139-45. DOI: 10.1097/00002517-199407020-00007. View

15.

McElhaney J, Fogle J, BYARS E, Weaver G . EFFECT OF EMBALMING ON THE MECHANICAL PROPERTIES OF BEEF BONE. J Appl Physiol. 1964; 19:1234-6. DOI: 10.1152/jappl.1964.19.6.1234. View

16.

Stromsoe K, Kok W, Hoiseth A, ALHO A . Holding power of the 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral. Injury. 1993; 24(10):656-9. DOI: 10.1016/0020-1383(93)90314-v. View

17.

Brown G, McCarthy T, Bourgeault C, Callahan D . Mechanical performance of standard and cannulated 4.0-mm cancellous bone screws. J Orthop Res. 2000; 18(2):307-12. DOI: 10.1002/jor.1100180220. View

18.

Thompson J, Benjamin J, Szivek J . Pullout strengths of cannulated and noncannulated cancellous bone screws. Clin Orthop Relat Res. 1997; (341):241-9. View

19.

Gantous A, Phillips J . The effects of varying pilot hole size on the holding power of miniscrews and microscrews. Plast Reconstr Surg. 1995; 95(7):1165-9. DOI: 10.1097/00006534-199506000-00004. View

20.

Oktenoglu B, Ferrara L, Andalkar N, Ozer A, Sarioglu A, Benzel E . Effects of hole preparation on screw pullout resistance and insertional torque: a biomechanical study. J Neurosurg. 2001; 94(1 Suppl):91-6. DOI: 10.3171/spi.2001.94.1.0091. View