Hybrid composite pedicle screw - finite element modelling with parametric optimization

Low-speed instrumented drill press for bone screw insertion

Screw insertion torque is a widely used/effective method for quantifying fixation strength in orthopedic implant research for different screw geometries, implantation sites, and loads. This work reports the construction of an open-source instrumented benchtop screw insertion device for a total cost of $7545 ($492 + $7053 for equipped sensors), as well as validation of the device and an example use-application. The insertion device is capable of recording the axial load, rotational speed, and applied torque throughout the screw insertion process at 10 samples per second, as demonstrated in the validation test. For this combination of bone analog (20 PCF Sawbones©), screw, and loading, the resolution of the torque sensor was 25% of the maximum measured torque; a different model torque sensor would be required to meet ASTM F543-17, which specifies a resolution of 10% of the maximum torque. This system is optimized for fastener insertion at speeds of 120 rpm or less and axial loading up to 50 N.

Influence of bone quality and pedicle screw design on the fixation strength during Axial Pull-out test: A 2D Axisymmetric FE study

Pedicle screw fixations are widely used to provide support and improve stability for the treatment of spinal pathologies. The effectiveness of treatment depends on the anchorage strength between the screw and bone. In this study, the influence of pedicle screw half-angle and bone quality on the displacement of fixation and stress transfer are analyzed using a 2D axisymmetric finite element model. The pedicle screw proximal half-angle is varied between 0° and 60° in steps of 10°, along with two different distal half-angles of 30° and 40°. Three bone models are considered for cancellous bone to simulate various degrees of bone quality, namely, poor, moderate and good. The mechanical properties of cortical bone are kept constant throughout the study. The material properties and boundary conditions are applied based on previous studies. Frictional contact is considered between the bone and screw. Results show that, the displacement of fixation is observed to be minimum at a proximal half angle of 0° and maximum at an angle of 60°, independent of bone quality. The highest implant displacement is observed in case of poor bone quality. All the bone model showed similar patterns of stress distribution, with high stress concentration around the first few threads. The highest peak von Mises stress is obtained at a proximal half-angle of 60°. Furthermore, the stress transfer increased with increase in proximal half-angle and bone quality, with maximum stress transfer at a proximal half-angle of 60°. It appears that, this study might aid to improve the design of pedicle screw for treatment of degenerative spinal diseases.Clinical Relevance- This study analyses the impact of bone quality on pedicle screw design.

Biomechanical Effects of a Cross Connector in Sacral Fractures - A Finite Element Analysis

Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.