Screw-Bone Implant Loosening: Complication, Cause and Assessment

  • Authors

    • M. A Ghani
    • M. K. Ali Hassan
    • R. Daud
    2018-11-30
    https://doi.org/10.14419/ijet.v7i4.26.22166
  • screw loosening, ultrasound, radiography, bolted joint, screw penetration
  • Abstract

    Bone fracture has become more common in this era of vehicular modernization. Internal fixation has been used in the treatment of such cases. The use of screw and plate in internal fixation has been proven to provide more stability to fracture to promote better healing. The use of screw also carries certain risk such as self-loosening that can cause non-union and prolong healing. The complication of self-loosening is studied to comprehend the danger of self-loosening in screw-bone implant. The review on self-loosening in bolted joint is done in this paper to gain better understanding on the nature of self-loosening phenomena. The factor that affects the screw self-loosening in bone is further studied in the screw-bone implant environment. The identification of the screw loosening can be done with radiography, CT scan, MRI and ultrasound. This article have done a brief review on the complication of screw self-loosening, the cause of screw loosening in bolted joint and screw-bone implant and the assessment of screw loosening done by ultrasound and radiography.

     

  • References

    1. [1] P. Pivonka and C. R. Dunstan, “Role of mathematical modeling in bone fracture healing,†Bonekey Rep., vol. 1, no. November, pp. 1–10, 2012.

      [2] M. S. Ghiasi, J. Chen, A. Vaziri, E. K. Rodriguez, and A. Nazarian, “Bone fracture healing in mechanobiological modeling: A review of principles and methods,†Bone Reports, vol. 6, pp. 87–100, 2017.

      [3] P. J. Harwood, J. B. Newman, and A. L. R. Michael, “(ii) An update on fracture healing and non-union,†Orthop. Trauma, vol. 24, no. 1, pp. 9–23, 2010.

      [4] G. L. Garcés, A. Yánez, A. Cuadrado, and O. Martel, “Influence of the number and position of stripped screws on plate–screw construct biomechanical properties,†Injury, vol. 48, pp. ix–x, 2017.

      [5] R. K. Pandey and S. S. Panda, “Bone drilling: An area seeking for improvement,†2011 Nirma Univ. Int. Conf. Eng. Curr. Trends Technol. NUiCONE 2011 - Conf. Proc., pp. 8–10, 2011.

      [6] N. K. Kanakaris, T. H. Tosounidis, and P. V Giannoudis, “Surgical management of infected non-unions : An update,†2015.

      [7] J. R. Adam and M. J. Woodruff, “Acute scaphoid fractures and non-unions,†pp. 257–265, 2017.

      [8] F. Galbusera, D. Volkheimer, S. Reitmaier, N. Berger-Roscher, A. Kienle, and H. J. Wilke, “Pedicle screw loosening: a clinically relevant complication?,†Eur. Spine J., vol. 24, no. 5, pp. 1005–1016, 2015.

      [9] H. Mehmanparast, Y. Petit, and J.-M. Mac-Thiong, “Comparison of Pedicle Screw Loosening Mechanisms and the Effect on Fixation Strength,†J. Biomech. Eng., vol. 137, no. 12, p. 121003, 2015.

      [10] M. Bhandari, P. Tornetta, B. Hanson, and M. F. Swiontkowski, “Optimal internal fixation for femoral neck fractures: Multiple screws or sliding hip screws?,†J. Orthop. Trauma, vol. 23, no. 6, pp. 403–407, 2009.

      [11] C. M. McAndrew, A. Agarwalla, A. C. Abraham, E. Feuchtbaum, W. M. Ricci, and S. Y. Tang, “Local bone quality measurements correlates with maximum screw torque at the femoral diaphysis,†Clin. Biomech., vol. 52, no. July 2017, pp. 95–99, 2018.

      [12] V. Perumal and C. S. Roberts, “(ii) Factors contributing to non-union of fractures,†Curr. Orthop., vol. 21, no. 4, pp. 258–261, 2007.

      [13] C. C. Hsu, C. K. Chao, J. L. Wang, S. M. Hou, Y. T. Tsai, and J. Lin, “Increase of pullout strength of spinal pedicle screws with conical core: Biomechanical tests and finite element analyses,†J. Orthop. Res., vol. 23, no. 4, pp. 788–794, 2005.

      [14] F. Dakhil-Jerew, H. Jadeja, A. Cohen, and J. A. N. Shepperd, “Inter-observer reliability of detecting Dynesys pedicle screw using plain X-rays: A study on 50 post-operative patients,†Eur. Spine J., vol. 18, no. 10, pp. 1486–1493, 2009.

      [15] H. Pihlajamäki, P. Myllynen, and O. Böstman, “Complications Of Transpedicular Lumbosacral Fixation For Non-traumatic Disorders,†J. Bone Jt. Surg., vol. 79, no. 2, pp. 183–189, 1997.

      [16] L. Bogunovic, S. M. Cherney, M. A. Rothermich, and M. J. Gardner, “Biomechanical Considerations for Surgical Stabilization of Osteoporotic Fractures,†Orthop. Clin., vol. 44, no. 2, pp. 183–200, Apr. 2013.

      [17] T. E. Mcmillan and A. J. Johnstone, “Technical considerations to avoid delayed and non-union,†pp. 64–68, 2017.

      [18] H. Simpson and S. T. J. Tsang, “Current treatment of infected non-union after intramedullary nailing,†Injury, 2017.

      [19] R. K. Lerner, J. L. Esterhai, R. C. Polomano, M. D. Cheatle, and R. B. Heppenstall, “Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation.,†Clin. Orthop. Relat. Res., no. 295, pp. 28–36, 1993.

      [20] R. D. Farnell and D. R. Dickson, “The assessment and management of acute scaphoid fractures and,†pp. 381–393, 2010.

      [21] T. A. Einhorn, “Enhancements of Fracture-Healing,†J. Bone Jt. Surg., vol. 77–A, no. 6, pp. 940–956, 1995.

      [22] Y. Jiang, M. Zhang, and C.-H. Lee, “A Study of Early Stage Self-Loosening of Bolted Joints,†J. Mech. Des., vol. 125, no. 3, p. 518, 2003.

      [23] T. Park and C. Lee, “An Experimental Study of Self-Loosening of Bolted Joints,†vol. 126, no. September 2004, pp. 925–931, 2018.

      [24] S. A. Nassar and P. H. Matin, “Clamp Load Loss due to Fastener Elongation Beyond its Elastic Limit,†J. Press. Vessel Technol., vol. 128, no. 3, p. 379, 2006.

      [25] G. H. Junker, “Criteria for self loosening of fasteners under vibration,†Aircr. Eng., vol. 45, no. 1, pp. 12–14, 1973.

      [26] N. G. Pai and D. P. Hess, “Experimental study of loosening of threaded fasteners due to dynamic shear loads,†J. Sound Vib., vol. 253, no. 3, pp. 585–602, 2002.

      [27] X. Jiang, Y. Zhu, J. Hong, X. Chen, and Y. Zhang, “Investigation into the loosening mechanism of bolt in curvic coupling subjected to transverse loading,†Eng. Fail. Anal., vol. 32, pp. 360–373, 2013.

      [28] G. Dinger and C. Friedrich, “Avoiding self-loosening failure of bolted joints with numerical assessment of local contact state,†Eng. Fail. Anal., vol. 18, no. 8, pp. 2188–2200, 2011.

      [29] M. Zhang, L. Lu, W. Wang, and D. Zeng, “The roles of thread wear on self-loosening behavior of bolted joints under transverse cyclic loading,†Wear, vol. 394–395, no. July 2017, pp. 30–39, 2018.

      [30] W. HORN and R. SCHMITT, “Relaxation in Bolted Thermoplastic Compositejoints,†34th Struct. Struct. Dyn. Mater. Conf., pp. 485–494, 1993.

      [31] J. Liu, H. Ouyang, Z. Feng, Z. Cai, X. Liu, and M. Zhu, “Study on self-loosening of bolted joints excited by dynamic axial load,†Tribol. Int., vol. 115, no. April, pp. 432–451, 2017.

      [32] B. A. Housari and S. A. Nassar, “Effect of Thread and Bearing Friction Coefficients on the Vibration-Induced Loosening of Threaded Fasteners,†vol. 129, no. August 2007, 2018.

      [33] A. F. Dinah, S. C. Mears, T. A. Knight, S. P. Soin, J. T. Campbell, and S. M. Belkoff, “Inadvertent Screw Stripping During Ankle Fracture Fixation in Elderly Bone,†Geriatr. Orthop. Surg. Rehabil., vol. 2, no. 3, pp. 86–89, 2011.

      [34] M. Wojtków, Å. Kubaszewski, G. Bajor, Z. KieÅ‚bowicz, J. Kaczmarczyk, and C. Pezowicz, “Biomechanical analysis of the durability of a modified S1 vertebrae transpedicular screws insertion technique,†Clin. Biomech., vol. 54, no. February 2017, pp. 118–124, 2018.

      [35] W. M. Ricci et al., “A comparison of screw insertion torque and pullout strength,†J. Orthop. Trauma, vol. 24, no. 6, pp. 374–378, 2010.

      [36] V. Palepu, M. D. Helgeson, M. Molyneaux-Francis, and S. Nagaraja, “Impact of bone quality on the performance of integrated fixation cage screws,†Spine J., vol. 18, no. 2, pp. 321–329, 2018.

      [37] K. N. Bachus, M. T. Rondina, and D. T. Hutchinson, “The effects of drilling force on cortical temperatures and their duration: An in vitro study,†Med. Eng. Phys., vol. 22, no. 10, pp. 685–691, 2000.

      [38] F. G. PALLAN, “Histological changes in bone after insertdon of skeletal fixation pins,†J. Oral Surg. Anesth. Hosp. Dent. Serv., vol. 18, p. 400—408, Sep. 1960.

      [39] R. A. Ibrahim and C. L. Pettit, “Uncertainties and dynamic problems of bolted joints and other fasteners,†J. Sound Vib., vol. 279, no. 3–5, pp. 857–936, 2005.

      [40] B. T. Oktenoğlu, L. a Ferrara, N. Andalkar, a F. Ozer, a C. Sarioğlu, and E. C. Benzel, “Effects of hole preparation on screw pullout resistance and insertional torque: a biomechanical study.,†J. Neurosurg., vol. 94, no. 1 Suppl, pp. 91–6, 2001.

      [41] C. Collinge, B. Hartigan, and E. P. Lautenschlager, “Effects of surgical errors on small fragment screw fixation,†J. Orthop. Trauma, vol. 20, no. 6, pp. 410–413, 2006.

      [42] G. S. Andreassen, P. R. Høiness, I. Skraamm, O. Granlund, and L. Engebretsen, “Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation,†Arch. Orthop. Trauma Surg., vol. 124, no. 3, pp. 161–165, 2004.

      [43] T. M. Cleek, K. J. Reynolds, and T. C. Hearn, “Effect of screw torque level on cortical bone pullout strength,†J. Orthop. Trauma, vol. 21, no. 2, pp. 117–123, 2007.

      [44] K. A. Egol, E. N. Kubiak, E. Fulkerson, F. J. Kummer, and K. J. Koval, “Biomechanics of locked plates and screws,†J. Orthop. Trauma, vol. 18, no. 8, pp. 488–493, 2004.

      [45] M. J. Stoesz, J. R. Jastifer, J. L. Chess, B. Patel, and P. A. Gustafson, “Surgeon Perception of Cancellous Screw Fixation,†no. 44809. pp. 1007–1008, 2012.

      [46] J. C. Litchfield, “The treatment of unstable fractures of the ankle in the elderly,†Injury, vol. 18, no. 2, pp. 128–132, 1987.

      [47] C. G. Beauchamp, N. R. Clay, and P. W. Thexton, “Displaced ankle fractures in patients over 50 years of age.,†J. Bone Joint Surg. Br., vol. 65, no. 3, pp. 329–32, 1983.

      [48] P. Vernet et al., “Detection of penetration of the dorsal cortex by epiphyseal screws of distal radius volar plates: Anatomical study comparing ultrasound and fluoroscopy,†Orthop. Traumatol. Surg. Res., vol. 103, no. 6, pp. 911–913, 2017.

      [49] S. Bianchi, J. van Aaken, T. Glauser, C. Martinoli, J.-Y. Beaulieu, and D. Della Santa, “Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance,†Am. J. Roentgenol., vol. 191, no. 5, pp. W199–W203, Nov. 2008.

      [50] T. S. Sügün, N. Karabay, Y. Gürbüz, K. Özaksar, T. Toros, and M. Kayalar, “Screw prominences related to palmar locking plating of distal radius,†J. Hand Surg. Eur. Vol., vol. 36, no. 4, pp. 320–324, 2011.

      [51] Y. Gurbuz, L. Kucuk, H. Gunay, K. Ozaksar, T. S. Sugun, and O. Bilge, “Comparison of ultrasound and dorsal horizon radiographic view for the detection of dorsal screw penetration,†Acta Orthop. Traumatol. Turc., vol. 51, no. 6, pp. 448–450, 2017.

      [52] L. C. Haug, B. Glodny, C. Deml, M. Lutz, and R. Attal, “A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures: The dorsal horizon view,†Bone Jt. J., vol. 95 B, no. 8, pp. 1101–1105, 2013.

      [53] B. Sandén, C. Olerud, M. Petrén-Mallmin, C. Johansson, and S. Larsson, “The significance of radiolucent zones surrounding pedicle screws,†J. Bone Joint Surg. Br., vol. 86–B, no. 3, pp. 457–461, 2004.

      [54] Chin-Chu Ko et al., “Screw loosening in the Dynesys stabilization system: radiographic evidence and effect on outcomes,†Neurosurg. Focus, vol. 28, no. 6, p. E10, 2010.

      [55] T. M. Stoll, G. Dubois, and O. Schwarzenbach, “The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system,†Arthroplast. Spine, vol. 11, pp. 114–122, 2004.

      [56] J. Schatzker, J. G. Horne, and G. Sumner-Smith, “The effect of movement on the holding power of screws in bone.,†Clinical orthopaedics and related research, no. 111. pp. 257–62, 1975.

      [57] K. Eckert, O. Ackermann, B. Schweiger, E. Radeloff, and P. Liedgens, “Ultrasound evaluation of elbow fractures in children,†J. Med. Ultrason., vol. 40, no. 4, pp. 443–451, 2013.

      [58] J. D. Moritz, L. D. Berthold, S. F. Soenksen, and G. F. Alzen, “Ultrasound in diagnosis of fractures in children: Unnecessary harassment or useful addition to X-ray?,†Ultraschall der Medizin, vol. 29, no. 3, pp. 267–274, 2008.

      [59] N. Raghav et al., “Comparison of the efficacy of conventional radiography, digital radiography, and ultrasound in diagnosing periapical lesions,†Oral Surgery, Oral Med. Oral Pathol. Oral Radiol. Endodontology, vol. 110, no. 3, pp. 379–385, 2010.

      [60] M. Mujagic, H. Ginsberg, and R. Cobbold, “Development of a method for ultrasound-guided placement of pedicle screws,†IEEE Trans. Ultrason. Ferroelectr. Freq. Control, vol. 55, no. 6, pp. 1267–1276, 2008.

      [61] K. J. Schnake, S. Schaeren, and B. Jeanneret, “Dynamic Stabilization in Addition to Decompression for Lumbar Spinal Stenosis.PDF,†vol. 31, no. 4, pp. 442–449, 2006.

      [62] A. Ohlin, M. Karlsson, H. Düppe, R. Hasserius, and I. Redlund-Johnell, “Complications after transpedicular stabilization of the spine. A survivorship analysis of 163 cases,†Spine (Phila. Pa. 1976)., vol. 19, no. 24, p. 2774—2779, Dec. 1994.

  • Downloads

  • How to Cite

    A Ghani, M., K. Ali Hassan, M., & Daud, R. (2018). Screw-Bone Implant Loosening: Complication, Cause and Assessment. International Journal of Engineering & Technology, 7(4.26), 194-198. https://doi.org/10.14419/ijet.v7i4.26.22166

    Received date: 2018-11-29

    Accepted date: 2018-11-29

    Published date: 2018-11-30