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Free Hand Insertion Technique of S2 Sacral Alar-Iliac Screws for Spino-Pelvic Fixation : Technical Note, Acadaveric Study

  • Park, Jong-Hwa;Hyun, Seung-Jae;Kim, Ki-Jeong;Jahng, Tae-Ahn
    • Journal of Korean Neurosurgical Society
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    • v.58 no.6
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    • pp.578-581
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    • 2015
  • A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.

Comparison of success rates of orthodontic mini-screws by the insertion method

  • Kim, Jung Suk;Choi, Seong Hwan;Cha, Sang Kwon;Kim, Jang Han;Lee, Hwa Jin;Yeom, Sang Seon;Hwang, Chung Ju
    • The korean journal of orthodontics
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    • v.42 no.5
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    • pp.242-248
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    • 2012
  • Objective: The aim of this study was to compare the success rates of the manual and motor-driven mini-screw insertion methods according to age, gender, length of mini-screws, and insertion sites. Methods: We retrospectively reviewed 429 orthodontic mini-screw placements in 286 patients (102 in men and 327 in women) between 2005 and 2010 at private practice. Age, gender, mini-screw length, and insertion site were cross-tabulated against the insertion methods. The Cochran-Mantel-Haenszel test was performed to compare the success rates of the 2 insertion methods. Results: The motor-driven method was used for 228 mini-screws and the manual method for the remaining 201 mini-screws. The success rates were similar in both men and women irrespective of the insertion method used. With respect to mini-screw length, no difference in success rates was found between motor and hand drivers for the 6-mm-long mini-screws (68.1% and 69.5% with the engine driver and hand driver, respectively). However, the 8-mmlong mini-screws exhibited significantly higher success rates (90.4%, p < 0.01) than did the 6-mm-long mini-screws when placed with the engine driver. The overall success rate was also significantly higher in the maxilla (p < 0.05) when the engine driver was used. Success rates were similar among all age groups regardless of the insertion method used. Conclusions: Taken together, the motor-driven insertion method can be helpful to get a higher success rate of orthodontic mini-screw placement.

DETORQUE FORCE OF TiN-COATED ABUTMENT SCREW WITH VARIOUS COATING THICKNESS AFTER REPEATED CLOSING AND OPENING

  • Kim, Han-Su;Kim, Hee-Jung;Chung, Chae-Heon
    • The Journal of Korean Academy of Prosthodontics
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    • v.45 no.6
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    • pp.769-779
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    • 2007
  • Statement of problem. When TiN coating is applied to the abutment screw, occurrence of greater preload and prevention of the screw loosening could be expected due to decrease of frictional resistance. However, the proper thickness of TiN coating on abutment screw has not been yet reported. Purpose. The purpose of this study is to find out the appropriate TiN coating thickness by evaluating the detorque force and the surface change of titanium abutment screw with various TiN coating thickness. Material and methods. 1. Material Thirty five non-coated abutment screws were prepared for TiN coating. TiN coatings were prepared by Arc ion plating method. Depending on the coating deposition time(CDT), experimental groups were divided into 6 groups(CDT 30min, 60min, 90min, 120min, 150min, 180min) and those of 1 group was not coated as a control group. Each group was made up of 5 abutment screws. 2. Methods FE-SEM(Field Emission Scanning Electron Microscoper) and EDX(Energy Dispersive X-ray Spectroscopy) were used to observe the surface of the abutment screw. Electric scales was used to measure the weight of the abutment screw after the repeated closing and opening of 10 trials. Detorque force was measured with digital torque gauge, at each trial. Results. 1. As the coating deposition time increased, the surface became more consistent and smooth. 2. As for the abutment screws that were TiN coated for more than 60 minutes, no surface change was found after the repeated closing and opening. 3. The TiN coated abutment screws showed less weight change than the non-coated abutment screws. 4. The TiN coated abutment screws showed higher mean detorque force than the noncoated abutment screws. 5. The abutment screw coated for 60 minutes showed the highest mean detorque force. Conclusion. The coating layer of proper thickness is demanded to obtain consistent and smooth coating surface, resistance to wear, and increased detorque force of the abutment screw. In conclusion, the coating deposition time of 60 minutes indicated improved mechanical property, when TiN coating was conducted on titanium abutment screw.

Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength (경추부의 후관절 나사못 고정술에서 단피질삽입법과 양피질 삽입법 간의 특성에 관한 비교)

  • Park, Choon-Keun;Hwang, Jang-Hoe;Ji, Chul;Lee, Jae Un;Sung, Jae Hoon;Choi, Seung-Jin;Lee, Sang-Won;Seybold, Eric;Park, Sung-Chan;Cho, Kyung-Suok;Park, Chun-Kun;Kang, Joon-Ki
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1210-1219
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    • 2001
  • Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

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Posterior Atlantoaxial Fixation with a Combination of Pedicle Screws and a Laminar Screw in the Axis for a Unilateral High-riding Vertebral Artery

  • Kim, Sei-Yoon;Jang, Jee-Soo;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.41 no.2
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    • pp.141-144
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    • 2007
  • A vertebral arte [VA] injury presents a difficult problem in atlantoaxial fixation. Recent technical reports described posterior C2 fixation using bilateral, crossing C2 laminar screws. The translaminar screw technique has the advantages of producing little risk of VA injury and the unconstrained screw placement. In addition, biomechanical studies have demonstrated the potential of the translaminar screw technique to provide a firmer construct that is equivalent to methods currently used. We report the successful treatment of C1-2 instability with a left-side high-riding VA. Because of the potential risk of VA injury, we performed a posterior C1-2 fixation with a combination of pedicle screws and a laminar screw in C2. We first placed bilateral C1 lateral mass screws and a right-side C2 pedicle screw. However, placement of the left- side C2 pedicle screw was technically difficult due to a narrow isthmus and pedicle. A laminar screw was inserted instead and authors believe that this posterior C1-C2 fixation with a combination of pedicle screws and a laminar screw in C2 can be a useful alternative technique for the treatment of C1-C2 instability in the presence of a unilateral high-riding VA.

SKELETAL RELAPSE AFTER SAGITTAL SPLIT RAMUS OSTEOTOMY AND SCREW FIXATION (하악전돌증에서 하악지 시상분할골절단 및 Screw고정후 골성회귀에 관한 연구)

  • Lee, Chang-Kug;Kim, Myung-Rae;Choi, Jang-Woo;Yun, Jung-Hoon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.4
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    • pp.563-569
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    • 1996
  • Skeletal and dental changes were examined in 38 patients of mandibular prognathism who been treated by a bilateral sagittal split osteotomy(SSRO) and internal fixation using titanium mini-screws. All patients were followed up for over 8 months after the surgeries, and postoperative cephalometric measurements were compared at 2 months and at 8 months. Linear measurements of the "Pog-most posterior screws" and angular measurementsts of "SN-Pog'were compared to figure out the change of bony fragments. The significancy of data were tested by unpaired T-test. The results were as follows : 1. The fixation screws were changed in cephalometric position as little as $0.32{\pm}2.51mm$ in SSRO and $0.15{\pm}1.00mm$ in SSRO & Le Fort I Osteotomy.(P<0.05) 2. Mandibular set-back over 5mm resulted in less stability of the fixation screws and higher relapse tendency. 3. The internal fixation using two screws along the inferior border and one on the superior ridge is considered to be very resistant to postoperative relapse of the repositioned bony segments.

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Evaluation of Clamping Characteristics for Subminiature Screws According to Thread Angle Variation (초소형 나사의 나사산 각도변화에 따른 체결특성 평가)

  • Min, Kyeong Bin;Kim, Jong Bong;Park, Keun;Ra, Seung Woo
    • Journal of the Korean Society for Precision Engineering
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    • v.31 no.9
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    • pp.839-846
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    • 2014
  • Recent trends in the miniaturization and weight reduction of portable electronic parts have driven the use of subminiature screws with a micrometer-scale pitch. As both screw length and pitch decrease in subminiature screws, the resulting clamping force becomes diminishes. In this work, Finite element (FE) analysis is performed to evaluate clamping force of a screw assembly, with a comparison with experimental result. To improve clamping force of subminiature screws, a new screw design is considered by modifying screw thread angle: the thread angle is varied as an asymmetric way unlike the conventional symmetric thread angle. FE analyses are then performed to compare the clamping characteristics of each subminiature screw with different thread angle. The effect of thread angles on the clamping force is then discussed in terms of structural safety for both positive and negative screws.

A Case of Osteotomy of the Distal Radius and Ulna with Panarthrodesis of Carpus for Reform of (성장판 조기페쇄에 따른 요척골 외전과 완관절 아탈구 교정들 위한 요척골 절단술 및 광범위 완관절 고술의 일례)

  • 이종일;김남수;최인혁
    • Journal of Veterinary Clinics
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    • v.17 no.2
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    • pp.485-489
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    • 2000
  • A 23.5 kg179, 8 months olds non-spaycd female Rottweiler dog was submitted to the veterinary teaching animal hospitals Chonbuk: national university, for chronic bitten trauma on right foreleg with pain, lameness, and pronation. The patient fought with a neighboring dog about five months ago and had mild anorexia, depression, bolt normal walking at that time. CBC and blood chemical examination were in normal range. Physical examination resulted in the right foreleg with edema and interval rotation of carpal joint. Radiograph of the right carpus showed varus and subluxation. We finally diagnosed the patient as the growth deformity of distal radius and ulna caused by medial premature closure of distal radial physis. Osteotomy was performed fur reforming of the varus of the distal radius and ulna with 6-hole straight plate and six 3.5 mm screws. Panarthrodcsis of carpus was preformed for correcting subluxation using 6-hole T-shaped plate and four 3.5 mm screws with cortical onlay autograft and strengthened by two 3.5 mm screws and tension wire band in lateral aspect of the carpus. Follow-up radiographs after 16 weeds of the surgery showed complete coaptation of osteotomy sire of the radius and uIna. After 6 months of the procedurc, talc plate, screws and the wire were removed except 7-shaped plate and four screws fur arthrodesis. The patient was seen in normal forelimb and could walk and run without lameness after 7 months of the procedure.

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Ergonomic Analysis of Screw Driver Workstation (스크류 드라이버 작업장의 인간공학적 분석에 관한 연구)

  • 박희석;국정훈
    • Proceedings of the ESK Conference
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    • 1995.04a
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    • pp.165-172
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    • 1995
  • Twenty six subject drove screws with a screw driver into thick wooden sheet at three vertical and horizontal locations. Subjects drive screws for 3 minutes at each location and they assessed the conditon using the psychophysical scale. An ANOVA showed that only vertical location was a signicant factor in determining the pain ratings of various body parts. Driving screws at elbow height on the vertical surface ans with the lower arm close to the body on the horizontal surface were the work locations with the smallest ratings of perceived pain and discomfort. Wearing gloves had significant effects on reducing the pain of the hand.

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An Experimental Study on the Chips Remove after the Tapping of Burring Face (버링면의 태핑가공후 칩제거에 관한 실험적연구)

  • 김세환;이종선
    • Proceedings of the Korean Society for Technology of Plasticity Conference
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    • 1994.03a
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    • pp.218-222
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    • 1994
  • The chassis of T.V, cassette, radio and telephone are made up thin-iron plates that makes a lot of female screws to assemble various parts. Then makes hole in the iron plate and forming female screws of burring face after the burring. Female screws forming in thin-iron plate is very difficult working then rolled forming process use of plastic deformation instead of cut forming. In this study goals are solve the trouble problem of industrial field and develop new model tap for prevent chips.

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