Augmented screwdrivers can increase the performance of orthopaedic surgeons compared with use of normal screwdrivers.

Orthopaedic screws insertion can be trivialised as a simple procedure, however it is frequently performed poorly. Limited work exists defining how well surgeons insert screws or whether augmented screwdrivers can aid surgeons to reduce stripping rates and optimise tightness. We aimed to establish the performance of surgeons inserting screws and whether this be improved with screwdriver augmentation. 302 orthopaedic surgeons tightened 10 non-locking screws to what they determined to be optimum tightness into artificial bone sheets. The confidence in the screw purchase was given (1-10). A further 10 screws were tightened, using an augmented screwdriver that indicated when a predetermined optimum tightness was reached. The tightness for unstripped insertions under normal conditions and with the augmented screwdriver were 81% (95% CI 79-82%)(n = 1275) and 70% (95% CI 69-72%)(n = 2577) (p < 0.001). The stripping rates were 58% (95% CI 54-61%) and 15% (95% CI 12-17%) respectively (p < 0.001). The confidences when using the normal and augmented screwdrivers respectively were 7.2 and 7.1 in unstripped insertions and 6.2 and 6.5 in stripped insertions. Performance improved with an augmented screwdriver, both in reduced stripping rates and greater accuracy in detecting stripping. Augmenting screwdrivers to indicate optimum tightness offer potentially enormous clinical benefits by improving screw fixation.

Screw tightness and stripping rates vary between biomechanical researchers and practicing orthopaedic surgeons.

BACKGROUND: Screws are the most frequently inserted orthopaedic implants. Biomechanical, laboratory-based studies are used to provide a controlled environment to investigate revolutionary and evolutionary improvements in orthopaedic techniques. Predominantly, biomechanical trained, non-surgically practicing researchers perform these studies, whilst it will be orthopaedic surgeons who will put these procedures into practice on patients. Limited data exist on the comparative performance of surgically and non-surgically trained biomechanical researchers when inserting screws. Furthermore, any variation in performance by surgeons and/or biomechanical researchers may create an underappreciated confounder to biomechanical research findings. This study aimed to identify the differences between surgically and non-surgically trained biomechanical researchers' achieved screw tightness and stripping rates with different fixation methods. METHODS: Ten orthopaedic surgeons and 10 researchers inserted 60 cortical screws each into artificial bone, for three different screw diameters (2.7, 3.5 and 4.5 mm), with 50% of screws inserted through plates and 50% through washers. Screw tightness, screw hole stripping rates and confidence in screw purchase were recorded. Three members of each group also inserted 30 screws using an augmented screwdriver, which indicated when optimum tightness was achieved. RESULTS: Unstripped screw tightness for orthopaedic surgeons and researchers was 82% (n = 928, 95% CI 81-83) and 76% (n = 1470, 95% CI 75-76) respectively (p < 0.001); surgeons stripped 48% (872/1800) of inserted screws and researchers 18% (330/1800). Using washers was associated with increased tightness [80% (95% CI 80-81), n = 1196] compared to screws inserted through plates [76% (95% CI 75-77), n = 1204] (p < 0.001). Researchers were more accurate in their overall assessment of good screw insertion (86% vs. 62%). No learning effect occurred when comparing screw tightness for the first 10 insertions against the last 10 insertions for any condition (p = 0.058-0.821). Augmented screwdrivers, indicating optimum tightness, reduced stripping rates from 34 to 21% (p < 0.001). Experience was not associated with improved performance in screw tightness or stripping rates for either group (p = 0.385-0.965). CONCLUSIONS: Surgeons and researchers showed different screw tightness under the same in vitro conditions, with greater rates of screw hole stripping by surgeons. This may have important implications for the reproducibility and transferability of research findings from different settings depending on who undertakes the experiments.

High-Resolution Cone-Beam Computed Tomography is a Fast and Promising Technique to Quantify Bone Microstructure and Mechanics of the Distal Radius.

Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking. Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 µm), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 µm), (3) CBCT (NewTom 5G, Cefla, @75 µm) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 µm-gold standard). The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R2 = 0.79) to XtremeCT (R2 = 0.76) and slightly worse than XtremeCT-II (R2 = 0.86) which were both processed with the standard manufacturer's technique. CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R2 [Formula: see text] 0.96). While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning.

Variations in non-locking screw insertion conditions generate unpredictable changes to achieved fixation tightness and stripping rates.

BACKGROUND: Screws are the most commonly inserted orthopaedic implants. However, several variables related to screw insertion and tightening have not been evaluated. This study aimed firstly to assess the effect of insertion variables on screw tightness, secondly to improve methodologies used by researchers when testing screw insertion techniques and thirdly to assess for any learning or fatigue effects when inserting screws. METHODS: Two surgeons tightened a total of 2280 non-locking, 3.5 mm cortical screws, with 120 screws inserted to what they felt to be optimum tightness whilst varying each of the following factors: different screwdrivers for measuring torque, screwdriver orientation, gloves usage, dominant/non-dominant hand usage, awareness to the applied torque (blinded, unblinded and re-blinded), four bone densities and seven cortical thicknesses. Screws were tightened to failure to determine stripping torque, which was used to calculate screw tightness - ratio between stopping and stripping torque. FINDINGS: Screw tightness increased with glove usage, being blinded to the applied torque and with denser artificial bone and with thinner cortices. Considering all the insertions performed, the two surgeons stopped tightening screws at difference values of tightness ((77% versus 66% (p < 0.001)). A learning effect was observed with some parameters including sterile gloves usage and non-dominant hand application. INTERPRETATION: Different insertion conditions frequently changed screw tightness for both surgeons. Given the influence of screw tightness on fixation stability, the variables investigated within this study should be carefully reported and controlled when performing biomechanical testing alongside practicing screw insertion under different conditions during surgical training.

Surgical performance when inserting non-locking screws: a systematic review.

Billions of screws are inserted by surgeons each year, making them the most commonly inserted implant. When using non-locking screws, insertion technique is decided by the surgeon, including how much to tighten each screw. The aims of this study were to assess, through a systematic review, the screw tightness and rate of material stripping produced by surgeons and the effect of different variables related to screw insertion.Twelve studies were included, with 260 surgeons inserting a total of 2793 screws; an average of 11 screws each, although only 1510 screws have been inserted by 145 surgeons where tightness was measured - average tightness was 78±10% for cortical (n = 1079) and 80±6% for cancellous screw insertions (n = 431).An average of 26% of all inserted screws irreparably damaged and stripped screw holes, reducing the construct pullout strength. Furthermore, awareness of bone stripping is very poor, meaning that screws must be considerably overtightened before a surgeon will typically detect it.Variation between individual surgeons' ability to optimally insert screws was seen, with some surgeons stripping more than 90% of samples and others hardly any. Contradictory findings were seen for the relationship between the tightness achieved and bone density.The optimum tightness for screws remains unknown, thus subjectively chosen screw tightness, which varies greatly, remains without an established target to generate the best possible construct for any given situation. Work is needed to establish these targets, and to develop methods to accurately and repeatably achieve them. Cite this article: EFORT Open Rev 2020;5:26-36. DOI: 10.1302/2058-5241.5.180066.

The Role of Parvalbumin, Sarcoplasmatic Reticulum Calcium Pump Rate, Rates of Cross-Bridge Dynamics, and Ryanodine Receptor Calcium Current on Peripheral Muscle Fatigue: A Simulation Study.

A biophysical model of the excitation-contraction pathway, which has previously been validated for slow-twitch and fast-twitch skeletal muscles, is employed to investigate key biophysical processes leading to peripheral muscle fatigue. Special emphasis hereby is on investigating how the model's original parameter sets can be interpolated such that realistic behaviour with respect to contraction time and fatigue progression can be obtained for a continuous distribution of the model's parameters across the muscle units, as found for the functional properties of muscles. The parameters are divided into 5 groups describing (i) the sarcoplasmatic reticulum calcium pump rate, (ii) the cross-bridge dynamics rates, (iii) the ryanodine receptor calcium current, (iv) the rates of binding of magnesium and calcium ions to parvalbumin and corresponding dissociations, and (v) the remaining processes. The simulations reveal that the first two parameter groups are sensitive to contraction time but not fatigue, the third parameter group affects both considered properties, and the fourth parameter group is only sensitive to fatigue progression. Hence, within the scope of the underlying model, further experimental studies should investigate parvalbumin dynamics and the ryanodine receptor calcium current to enhance the understanding of peripheral muscle fatigue.

Efficacy and effectiveness of alcohol in the disinfection of semi-critical materials: a systematic review.

OBJECTIVE: to assess the efficacy and the effectiveness of 60-80% alcohol (v/v) in the disinfection of semi-critical materials which were either previously cleaned or not. METHOD: studies obtained from BIREME, IBECS, MEDLINE, ScIELO, PubMed, Ask Medline web portals, and references from other studies. Criteria were created to assess the methodological quality of articles. Out of the 906 studies found, 14 have been included. RESULTS: after materials were disinfected with alcohol, microorganisms were detected in 104/282 (36.9%) effectiveness tests and in 23/92 (25.0%) efficacy tests that were conducted. In the field studies, disinfection was not achieved for 74/218 (33.9%) of the products that were submitted to previous cleaning and for 30/64 (46.9%) of the ones which were not submitted to previous cleaning. In the experimental studies, alcohol disinfection was not efficacy in 11/30 (36.7%) and 12/62 (19.4%) of products, respectively. The studies were not found to have followed standardized methods. CONCLUSION: disinfection of semi-critical products with alcohol 70% - or in an approximate concentration - cannot be recommended to all health care products in an unrestricted way. However, according to the type of semi-critical product, disinfection can be attained with or without previous cleaning.

Efficacy and effectiveness of alcohol in the disinfection of semi-critical materials: a systematic review / Eficácia e efetividade do álcool na desinfecção de materiais semicríticos: revisão sistemática / Eficacia y efectividad del alcohol en la desinfección de materiales semicríticos: revisión sistemática

AbstractObjective: to assess the efficacy and the effectiveness of 60-80% alcohol (v/v) in the disinfection of semi-critical materials which were either previously cleaned or not.Method: studies obtained from BIREME, IBECS, MEDLINE, ScIELO, PubMed, Ask Medline web portals, and references from other studies. Criteria were created to assess the methodological quality of articles. Out of the 906 studies found, 14 have been included.Results: after materials were disinfected with alcohol, microorganisms were detected in 104/282 (36.9%) effectiveness tests and in 23/92 (25.0%) efficacy tests that were conducted. In the field studies, disinfection was not achieved for 74/218 (33.9%) of the products that were submitted to previous cleaning and for 30/64 (46.9%) of the ones which were not submitted to previous cleaning. In the experimental studies, alcohol disinfection was not efficacy in 11/30 (36.7%) and 12/62 (19.4%) of products, respectively. The studies were not found to have followed standardized methods.Conclusion: disinfection of semi-critical products with alcohol 70% - or in an approximate concentration - cannot be recommended to all health care products in an unrestricted way. However, according to the type of semi-critical product, disinfection can be attained with or without previous cleaning.

ResumoObjetivo:avaliar a eficácia e efetividade do álcool 60-80% (p/v), na desinfecção de materiais semicríticos, com ou sem limpeza prévia.Método:estudos obtidos do portal BIREME, IBECS, MEDLINE, SciELO, PubMed, Ask Medline e referências de outros estudos. Critérios de julgamento da qualidade metodológica dos artigos foram elaborados. Dos 906 estudos encontrados, 14 foram incluídos.Resultados:após a desinfecção com álcool, dos 282 testes de efetividade e 92 de eficácia, em 104 (36,9%) e em 23 (25,0%) houve detecção de microrganismos, respectivamente. Nos estudos de campo, a desinfecção não foi alcançada em 74/218 (33,9%) dos produtos submetidos à limpeza prévia e em 30/64 (46,9%) não submetidos à limpeza prévia, e nos estudos experimentais a desinfecção do álcool não foi eficaz em 11/30 (36,7%) e 12/62 (19,4%) dos produtos, respectivamente. Encontrou-se ausência de padronização dos métodos dos estudos.Conclusão:a desinfecção de produtos semicríticos com álcool 70%, ou em concentração aproximada, não pode ser recomendada de forma irrestrita a todos os produtos para saúde. Porém, de acordo com o tipo do produto semicrítico a desinfecção pode ser alcançada com e sem limpeza prévia.

ResumenObjetivo:evaluar la eficacia y la efectividad del alcohol 60-80% (p/v) en la desinfección de materiales semicríticos, con o sin limpieza previa.Método:estudios obtenidos del portal BIREME, IBECS, MEDLINE, SciELO, PubMed, Ask Medline y referencias de otros estudios. Se elaboraron criterios para juzgar la calidad metodológica de los artículos. De los 906 estudios encontrados, se incluyeron 14.Resultados:después de la desinfección con alcohol, de las 282 pruebas de efectividad y 92 de eficacia, en 104 (36,9%) y en 23 (25,0%) hubo detección de microorganismos, respectivamente. En los estudios de campo, la desinfección no se alcanzó en 74/218 (33,9%) de los productos sometidos a la limpieza previa y en 30/64 (46,9%) no sometidos a la limpieza previa, y en los estudios experimentales la desinfección del alcohol no fue eficaz en 11/30 (36,7%) y 12/62 (19,4%) de los productos, respectivamente. Se encontró ausencia de normalización de los métodos de los estudios.Conclusión:la desinfección de productos semicríticos con alcohol 70% o en concentración aproximada no puede ser recomendada de forma irrestricta a todos los artículos de salud. Sin embargo, en consonancia con el tipo del producto semicrítico, la desinfección puede ser alcanzada con y sin limpieza previa.