Highlights
- •Residual drill holes in composite tibia significantly reduce torque-to-failure from intact.
- •A 28.4% to 38.4% reduction in tibia strength was observed.
- •Clinicians should consider long bone strength when creating and managing residual bone defects.
Abstract
Background
The etiology of bone refractures after screw removal can be attributed to residual
drill hole defects. This biomechanical study compared the torsional strength of bones
containing various sized cortical drill defects in a tibia model.
Methods
Bicortical drill hole defects of 3 mm, 4 mm, and 5 mm diameters were tested in 26
composite tibias versus intact controls without a drill defect. Each tibia was secured
in alignment with the rotational axis of a materials testing system and the proximal
end rotated internally at a rate of 1 deg./s until mechanical failure.
Findings
All defect test groups were significantly lower (P < 0.01) in torque-to-failure than the intact group (82.80 ± 3.70 Nm). The 4 mm drill
hole group was characterized by a significantly lower (P = 0.021) torque-to-failure (51.00 ± 3.27 Nm) when compared to the 3 mm drill hole
(59.00 ± 5.48 Nm) group, but not different than the 5 mm hole group (55.71 ± 5.71 Nm).
All bones failed through spiral fractures, bones with defects also exhibited posterior
butterfly fragments.
Interpretation
All the tested drill hole sizes in this study significantly reduced the torque-to-failure
from intact by a range of 28.4% to 38.4%, in agreement with previous similar studies.
The 5 mm drill hole represented a 22.7% diameter defect, the 4 mm drill hole a 18.2%
diameter defect, and the 3 mm drill hole a 13.6% diameter defect. Clinicians should
be cognizant of this diminution of long bone strength after a residual bone defect
in their creation and management of patient rehabilitation programs.
Keywords
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Article Info
Publication History
Published online: May 27, 2022
Accepted:
May 24,
2022
Received:
October 1,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
