OBJECTIVE: Screw failure of cancellous bone screws is not uncommon. To compare the effect of varying pilot-hole size on pullout strength of cancellous bone screws in human cadaveric bone, we designed and performed a biomechanical study to allow quantitative analysis. METHODS: Three pairs of distal femurs and 4 pairs of proximal tibias from embalmed human cadavers were stabilized in a mould, and the bone cortex was overdrilled. Four sites in a linear transverse plane were randomly assigned, anatomically matched with the paired bone and drilled with either pilot-hole size 3.2 mm or 2.5 mm. The cancellous screw (Synthes noncannulated 4.5-mm shaft, 6.5-mm external diameter) was guided into the pilot hole and pulled on by a test frame (Instron 8874 biaxial servo-hydraulic test frame) with increasing force to the point of failure, and the forces at which failure resulted were compared. RESULTS: A comparison of 25 anatomically paired sites with a 2-tailed paired t test and Wilcoxon matched-pairs signed rank test indicated significantly stronger pullout strength (p = 0.047 and p = 0.047) of the 2.5-mm compared with the 3.2-mm pilot hole. Subanalysis of the 4 studied locations indicated that 3 supported the above findings and 1 supported a reverse trend. CONCLUSIONS: Generally, cancellous screws demonstrated a significantly (p < 0.05) stronger hold using a smaller size pilot hole than the recommended standard diameter. All locations except the inner lateral site supported this finding.
RCT Entities:
OBJECTIVE: Screw failure of cancellous bone screws is not uncommon. To compare the effect of varying pilot-hole size on pullout strength of cancellous bone screws in human cadaveric bone, we designed and performed a biomechanical study to allow quantitative analysis. METHODS: Three pairs of distal femurs and 4 pairs of proximal tibias from embalmed human cadavers were stabilized in a mould, and the bone cortex was overdrilled. Four sites in a linear transverse plane were randomly assigned, anatomically matched with the paired bone and drilled with either pilot-hole size 3.2 mm or 2.5 mm. The cancellous screw (Synthes noncannulated 4.5-mm shaft, 6.5-mm external diameter) was guided into the pilot hole and pulled on by a test frame (Instron 8874 biaxial servo-hydraulic test frame) with increasing force to the point of failure, and the forces at which failure resulted were compared. RESULTS: A comparison of 25 anatomically paired sites with a 2-tailed paired t test and Wilcoxon matched-pairs signed rank test indicated significantly stronger pullout strength (p = 0.047 and p = 0.047) of the 2.5-mm compared with the 3.2-mm pilot hole. Subanalysis of the 4 studied locations indicated that 3 supported the above findings and 1 supported a reverse trend. CONCLUSIONS: Generally, cancellous screws demonstrated a significantly (p < 0.05) stronger hold using a smaller size pilot hole than the recommended standard diameter. All locations except the inner lateral site supported this finding.