A biomechanical study of top screw pullout in anterior scoliosis correction constructs

Study Design: Biomechanical testing of vertebral body screw pullout resistance with relevance to top screw pullout in endoscopic anterior scoliosis constructs. Objectives: To analyse the effect of screw positioning and angulation on pullout resistance of vertebral body screws, where the pullout takes place along a curved path as occurs in anterior scoliosis constructs. Summary of Background Data: Top screw pullout is a significant clinical problem in endoscopic anterior scoliosis surgery, with rates of up to 18% reported in the literature. Methods: A custom designed biomechanical test rig was used to perform pullout tests of Medtronic anterior vertebral screws where the pullout occurred along an arc of known radius. Using synthetic bone blocks, a range of pullout radii and screw angulations were tested, in order to determine an ‘optimal’ configuration. The optimal configuration was then compared with standard screw positioning using a series of tests on ovine vertebrae (n=29). Results: Screw angulation has a small but significant effect on pullout resistance, with maximum strength being achieved at 10 degree cephalad angulation. Combining 10 degree cephalad angulation with maximal spacing between the top two screws (maximum pullout radius) increased the pullout resistance by 88% compared to ‘standard’ screw positioning (screws inserted perpendicular to rod at mid-body height). Conclusions: The positioning of the top screw in anterior scoliosis constructs can significantly alter its pullout resistance.

The effect of insertion time on the axial pullout strength of anterior vertebral body screws

Top screw pullout occurs when the screw is under too much axial force to remain secure in the vertebral body. In vitro biomechanical pullout tests are commonly done to find the maximum fixation strength of anterior vertebral body screws. Typically, pullout tests are done instantaneously where the screw is inserted and then pulled out immediately after insertion. However, bone is a viscoelastic material so it shows a time dependent stress and strain response. Because of this property, it was hypothesised that creep occurs in the vertebral trabecular bone due to the stress caused by the screw. The objective of this study was therefore to determine whether the axial pullout strength of anterior vertebral body screws used for scoliosis correction surgery changes with time after insertion. This study found that there is a possible relationship between pullout strength and time; however more testing is required as the sample numbers were quite small. The design of the screw is made with the knowledge of the strength it must obtain. This is important to prevent such occurrences as top screw pullout. If the pullout strength is indeed decreased due to creep, the design of the screw may need to be changed to withstand greater forces.

Caracterização físico-mecânica de painéis de partículas de bambu com adição de casca de café

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Propriedades físico-mecânicas de painéis de mdp (medium density particleboard) constituído de bambu e fibra de coco

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Second-Generation Orthopaedic Measurement Device for in-vivo Assessment of Bone Quality

There are two main types of bone in the human body, trabecular and cortical bone. Cortical bone is primarily found on the outer surface of most bones in the body while trabecular bone is found in vertebrae and at the end of long bones (Ross 2007). Osteoporosis is a condition that compromises the structural integrity of trabecular bone, greatly reducing the ability of the bone to absorb energy from falls. The current method for diagnosing osteoporosis and predicting fracture risk is measurement of bone mineral density. Limitations of this method include dependence on the bone density measurement device and dependence on type of test and measurement location (Rubin 2005). Each year there are approximately 250,000 hip fractures in the United States due to osteoporosis (Kleerekoper 2006). Currently, the most common method for repairing a hip fracture is a hip fixation surgery. During surgery, a temporary guide wire is inserted to guide the permanent screw into place and then removed. It is believed that directly measuring this screw pullout force may result in a better assessment of bone quality than current indirect measurement techniques (T. Bowen 2008-2010, pers. comm.). The objective of this project is to design a device that can measure the force required to extract this guide wire. It is believed that this would give the surgeon a direct, quantitative measurement of bone quality at the site of the fixation. A first generation device was designed by a Bucknell Biomedical Engineering Senior Design team during the 2008- 2009 Academic Year. The first step of this project was to examine the device, conduct a thorough design analysis, and brainstorm new concepts. The concept selected uses a translational screw to extract the guide wire. The device was fabricated and underwent validation testing to ensure that the device was functional and met the required engineering specifications. Two tests were conducted, one to test the functionality of the device by testing if the device gave repeatable results, and the other to test the sensitivity of the device to misalignment. Guide wires were extracted from 3 materials, low density polyethylene, ultra high molecular weight polyethylene, and polypropylene and the force of extraction was measured. During testing, it was discovered that the spring in the device did not have a high enough spring constant to reach the high forces necessary for extracting the wires without excessive deflection of the spring. The test procedure was modified slightly so the wires were not fully threaded into the material. The testing results indicate that there is significant variation in the screw pullout force, up to 30% of the average value. This significant variation was attributed to problems in the testing and data collection, and a revised set of tests was proposed to better evaluate the performance of the device. The fabricated device is a fully-functioning prototype and further refinements and testing of the device may lead to a 3rd generation version capable of measuring the screw pullout force during hip fixation surgery.

Correlation of Pullout Force of Kirschner (K-) Wire to Other Factors Indicative of Bone Quality

More than 250,000 hip fractures occur annually in the United States and the most common fracture location is the femoral neck, the weakest region of the femur. Hip fixation surgery is conducted to repair hip fractures by using a Kirschner (K-) wire as a temporary guide for permanent bone screws. Variation has been observed in the force required to extract the K-wire from the femoral head during surgery. It is hypothesized that a relationship exists between the K-wire pullout force and the bone quality at the site of extraction. Currently, bone mineral density (BMD) is used as a predictor for bone quality and strength. However, BMD characterizes the entire skeletal system and does not account for localized bone quality and factors such as lifestyle, nutrition, and drug use. A patient’s BMD may not accurately describe the quality of bone at the site of fracture. This study aims to investigate a correlation between the force required to extract a K-wire from femoral head specimens and the quality of bone. A procedure to measure K-wire pullout force was developed and tested with pig femoral head specimens. The procedure was implemented on 8 human osteoarthritic femoral head specimens and the average pullout force for each ranged from 563.32 ± 240.38 N to 1041.01 ± 346.84 N. The data exhibited significant variation within and between each specimen and no statistically significant relationships were determined between pullout force and patient age, weight, height, BMI, inorganic to organic matter ratio, and BMD. A new testing fixture was designed and manufactured to merge the clinical and research environments by enabling the physician to extract the K-wire from each bone specimen himself. The new device allows the physician to gather tactile feedback on the relative ease of extraction while load history is recorded similar to the previous procedure for data acquisition. Future work will include testing human bones with the new device to further investigate correlations for predicting bone quality.

From the account manager’s conscience to top-of-mind : account planning in Australia

What began as the “account manager’s conscience” has grown to be top-of-mind in Australian advertising today. Account planning is a hybrid discipline which uses research to bring the consumer voice to the campaign process during strategy generation, creative development and evaluation. In Australia, account planning is subjected to the “Vegemite Factor” where planners are spread too thinly across accounts and much of the market is dominated by freelance researchers and planners. This unique environment has shaped many different perceptions of account planning in Australia. These are compared with an international definition of account planning and the current research. While many basic tenants of the definition are shared by Australian advertising professionals, the difference appears to be in the ongoing nature, team approach and level of commitment. In Australia, account planners seem to be more facilitators of the strategic direction, than directors of it. Instead of exerting a sustained influence across the campaign, most energy appears to be expended at the start of campaign development, rather than extending through to its evaluation.

Optimisation of performance in top level athletes : an action-based coping approach : a commentary

INTRODUCTION In their target article, Yuri Hanin and Muza Hanina outlined a novel multidisciplinary approach to performance optimisation for sport psychologists called the Identification-Control-Correction (ICC) programme. According to the authors, this empirically-verified, psycho-pedagogical strategy is designed to improve the quality of coaching and consistency of performance in highly skilled athletes and involves a number of steps including: (i) identifying and increasing self-awareness of ‘optimal’ and ‘non-optimal’ movement patterns for individual athletes; (ii) learning to deliberately control the process of task execution; and iii), correcting habitual and random errors and managing radical changes of movement patterns. Although no specific examples were provided, the ICC programme has apparently been successful in enhancing the performance of Olympic-level athletes. In this commentary, we address what we consider to be some important issues arising from the target article. We specifically focus attention on the contentious topic of optimization in neurobiological movement systems, the role of constraints in shaping emergent movement patterns and the functional role of movement variability in producing stable performance outcomes. In our view, the target article and, indeed, the proposed ICC programme, would benefit from a dynamical systems theoretical backdrop rather than the cognitive scientific approach that appears to be advocated. Although Hanin and Hanina made reference to, and attempted to integrate, constructs typically associated with dynamical systems theoretical accounts of motor control and learning (e.g., Bernstein’s problem, movement variability, etc.), these ideas required more detailed elaboration, which we provide in this commentary.

Strategic short termism as an issue of top-teams’ temporal orientation

Short-termism among firms, the tendency to excessively discount long-term benefits and favour less valuable short-term benefits, has been a prominent issue in business and public policy debates but research to date has been inconclusive. We study how managers frame, interpret, and resolve problems of intertemporal choice in actual decisions by using computer aided text analysis to measure the frequency of top-team temporal references in 1653 listed Australian firms between 1992-2005. Contrary to short-termism arguments we find evidence of a significant general increase in Future orientation and a significant decrease in Current/Past orientation. We also show top-teams’ temporal orientation is related to their strategic orientation, specifically the extent to which they focus on Innovation-Expansion and Capacity Building.

Top Gear, top journalism : three lessons for political journalists from the world's most popular TV show

This article examines the BBC program Top Gear, discussing why it has become one of the world’s most-watched TV programs, and how it has very successfully captivated an audience who might otherwise not be particularly interested in cars. The analysis of the show is here framed in the form of three ‘lessons’ for journalists, suggesting that some of the entertaining (and highly engaging) ways in which Top Gear presents information to its viewers could be usefully applied in the coverage of politics – a domain of knowledge which, like cars, many citizens find abstract or boring.