The decline and fall of Samuel Sawbones, M.D., on the Klondike. Microform

References: Storm, Catalogue of the Everett D. Graff Collection, no. 2452.

Can larger cemented femoral components reduce periprosthetic fractures?

Introduction The risk for late periprosthetic fractures is higher in patients treated for a neck of femur fracture compared to those treated for osteoarthritis. It has been hypothesised that osteopenia and consequent decreased stiffness of the proximal femur are responsible for this. We investigated if a femoral component with a bigger body would increase the torque to failure in a biaxially loaded composite sawbone model. Method A biomechanical composite sawbone model was used. Two different body sizes (Exeter 44-1 vs 44-4) of a polished tapered cemented stem were implanted by an experienced surgeon, in 7 sawbones each and loaded at 40 deg/s internal rotation until failure. Torque to fracture and fracture energy were measured using a biaxial materials testing device (Instron 8874). Data are non-parametric and tested with Mann-Whitney U-test. Results The mean torque load to fracture was 154.1 NM (SD 4.4) for the 44-1 stem and 229 NM (SD10.9) for the 44-4 stem (p = 0.01). The mean fracture energy was 9.6 J (SD1.2) for the 44-1 stem and 17.2 J (SD2.0) for the 44-4 stem (p = 0.14). Conclusion the use of a large body polished tapered cemented stem for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Fracture load for short versus standard cemented hip stems : an experimental in vitro study

Introduction: In an attempt to reduce stress shielding in the proximal femur multiple new shorter stem design have become available. We investigated the load to fracture of a new polished tapered cemented short stem in comparison to the conventional polished tapered Exeter stem. Method: A total of forty-two stems, twenty-one short stems and twenty-one conventional stems both with three different offsets were cemented in a composite sawbone model and loaded to fracture. Results: study showed that femurs will break at a significantly lower load to failure with a shorter compared to conventional length Exeter stem. Conclusion: This Both standard and short stem design are safe to use as the torque to failure is 7–10 times as much as the torques seen in activities of daily living.

Avaliação da resistência ao arrancamento de mini-implantes ortodônticos: estudo laboratorial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A prototype bone screw design for osteoporotic bone

Poster. Introduction: One in five menand one half of women over the age of 50 will experience a bone fracture, whichis frequently accompanied by poor bone health. This combination of poor bonehealth and fracture is a two edge sword, because not only does poor bone healthmake fractures more likely, it also reduces the efficacy of standard fracturetreatments. Currently available surgical fixation devices that were originallydeveloped for healthy bone, such as pins, plates and bone screws, are often noteffective for patients with osteoporosis, resulting in unsatisfactory outcomesor longer and more painful recovery times. One major issue is the design ofbone screws, which can loosen or pull-out from osteoporotic bone. Osteopenicscrews with larger outer thread diameters have been developed to try andaddress this problem. The larger diameter screws have been shown to be 60–70 %stronger in lab tests of individual screws but the larger diameter screwscannot be used with the standard spacing in fixation plates without the risk ofcausing fractures between the screws. In addition, many fractures occur nearjoints where there is not room to increase the spacing between screws.Therefore, new bone screws are needed for treatment of fractures in osteoporoticbone. Materials and Methods: Afterdeveloping a novel bone screw design, we fabricated screws using rapidprototyping methods. Screws were inserted into 10 pcf density sawbones polyurethanefoam as a model for osteoporotic bone. Pull-out tests were conducted using theprototype bone screw design and the standard screw design for comparison inaccordance with ASTM 543-13. Results and Discussion: Ourprototype screws have the same outer diameter as standard bone screws, but haveoptimised threads. For pull-out tests in 10 psf density sawbones poly-urethanefoam, the prototype screw design was 60 % stronger than the standard bone screwdesign (p<0.01). Conclusion: Our novel bonescrew design provides significant improvement in standard tests with syntheticbone material. Additional tests are needed to determine if the bone screwswould be suitable for human trials.