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2017 ; 11
(ä): 6
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Introducing the "Bone-Screw-Fastener" for improved screw fixation in orthopedic
surgery: a revolutionary paradigm shift?
#MMPMID28321265
Stahel PF
; Alfonso NA
; Henderson C
; Baldini T
Patient Saf Surg
2017[]; 11
(ä): 6
PMID28321265
show ga
BACKGROUND: Conventional screws used for fracture fixation in orthopedic surgery
continue to rely on the historic buttress thread design. While buttress screws
generally provide solid resistance against unidirectional axial loading forces,
their design suffers from several limitations, as the buttress thread does not
adequately resist multiaxial forces. Furthermore, the buttress screw is prone to
stripping at the bone-screw interface and can cause microfracturing of the
surrounding bone due to its thread design. Standard buttress screws are therefore
at risk of adverse postoperative outcomes secondary to failure of bone fixation.
A new patented Bone-Screw-Fastener was recently designed that is based on an
interlocking thread technology. This new fastener provides distributive forces
from the threads onto the bone and therefore resists loads in multiple
directions. The underlying concept is represented by a "female thread" bone
cutting technology designed to maximize bone volume, preserve bone architecture,
and create a circumferential interlocking interface between the implant and bone
that protects the thread from stripping and from failing to multiaxial forces.
PRESENTATION OF THE HYPOTHESIS: We hypothesize that the new Bone-Screw-Fastener
overcomes the classic shortcomings of conventional orthopedic screws with
buttress threads by ease of insertion, improved bone preservation, increased
resistance to off-axis multidirectional loading forces and to stripping of the
threads. These advanced biomechanical and biological properties can potentially
mitigate the classic limitations of conventional buttress screws by providing
better resistance to implant failure under physiological loads, preserving bone
biology, and thus potentially improving patient outcomes in the future. TESTING
THE HYPOTHESIS: The presumed superiority of the new fastener will require testing
and validation in well-designed prospective multicenter randomized controlled
trials (RCTs), using the conventional buttress screw as control. IMPLICATIONS OF
THE HYPOTHESIS: Once validated in multicenter RCTs, the new Bone-Screw-Fastener
may drive a change in paradigm with regard to its innovative biomechanical
principles and biologic bone preservation for surgical applications requiring
screw fixation.