Metal Screws Research Articles

Structural Design and Numerical Analysis of an All-Metal Screw Motor for Drilling Applications in High-Temperature and High-Pressure Environments in Ultra-Deep Wells

It is difficult to adapt traditional screw motors with rubber stators to the high-temperature and high-pressure conditions in ultra-deep wells, where rubber stators age, deform and carbonize, resulting in motor failure. In this study, the goal is to develop volumetric power drilling tools that can be used to drill at depths of 10,000 m. To meet this goal, an all-metal screw motor that can be applied in ultra-deep wells is designed, then its deformation and structural design are studied. Through numerical simulation, the change in clearance of the motor after expansion in high-temperature environments and the characteristics of deformation in ultra-deep well environments are analyzed. The results show that the metal screw motor has good performance and stability. The maximum deformation is less than 0.3 mm at depths of 9000~15,000 m in ultra-deep wells. The minimum design clearance should be greater than 0.2 mm to ensure that the stator and rotor remain engaged. The results of this research are expected to provide theoretical guidance for the design of all-metal screw motors for applications in ultra-deep well drilling projects to meet the demand for deep earth resource development.

Remote Reconfiguration of Microwave Filters Using Dielectric Tuners

The objective of this article is to explore the use of dielectrics to reconfigure remotely microwave filters in rectangular waveguide. To start, we study experimentally the phase shift that is achievable using dielectric tuning elements in a rectangular waveguide. We then compare the results obtained with the performance of standard metallic tuning cylinders and screws. Next, the passive intermodulation (PIM) behavior of dielectric tuning elements is investigated experimentally. The PIM results obtained using dielectrics are then compared with the ones of metallic tuning elements. After that, the measured results for a filter tuned with a number of different dielectric tuning elements are discussed to identify the required relation between cavity size, dielectric constant, and tuner diameter. As a proof of concept, we then design, manufacture, and test two filters, one in WR75 and the other in WR90. Both simulated and measured results are then presented clearly demonstrating that the structures discussed can indeed be reconfigured (or tuned) both in terms of filter center frequency and bandwidth. Finally, computer-driven linear actuators are connected to the dielectric tuners, and the remote tuning capability is successfully demonstrated.

The Hybrid Transtibial Technique Using the LARS Device in Primary Anterior Cruciate Ligament Reconstruction

Background: The recently published hybrid transtibial technique (HTT) using the Pathfinder Guide with a flexible transtibial technique (TT) guide wire may represent a beneficial combination of both the anteromedial portal and TT technique. The HTT has been described as especially suitable for anterior cruciate ligament (ACL) reconstruction in adolescents or ACL revision. However, we also found that the HTT worked for primary ACL reconstruction in adults also using the Ligament Advanced Reinforcement System (LARS). Indications: Acute ACL rupture in active patients who are eager to return to sports quickly. Technique Description: The HTT combined with the conventional LARS reconstruction procedure improves the placement of the femoral tunnel, which involves a guiding vessel clamp through the anteromedial portal combined with a 2.0 mm Kirschner wire via the tibial tunnel. Finally, we used a metal screw for fixation of the ligament. Results: The patient experienced satisfactory reconstruction of his ACL and regained active range of motion in 1 month and a full return to sports in 6 months. Discussion/Conclusion: The HTT using the LARS for primary ACL reconstruction is easy, safe, and reproducible. This combined technique has not yet been published and it may provide good functional results that allow patients to recover quickly and return to sports as soon as possible. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Low-Profile Cartilage Repair With Knotless All-Suture Anchors: Surgical Technique

Osteochondral and pure chondral lesions of the knee are common after patellar dislocations. There are multiple described techniques for the fixation of these lesions, including metallic screws, bioabsorbable screws, bioabsorbable implants, and suture devices. The purpose of this article is to describe a surgical technique for surgical fixation of a lateral condyle chondral lesion using knotless all-suture anchors, with second-look knee arthroscopy illustrating healing of the cartilage repair.

Metal artifact reduction and clinical verification in oral and maxillofacial region based on deep learning

Objective: To construct a kind of neural network for eliminating the metal artifacts in CT images by training the generative adversarial networks (GAN) model, so as to provide reference for clinical practice. Methods: The CT data of patients treated in the Department of Radiology, West China Hospital of Stomatology, Sichuan University from January 2017 to June 2022 were collected. A total of 1 000 cases of artifact-free CT data and 620 cases of metal artifact CT data were obtained, including 5 types of metal restorative materials, namely, fillings, crowns, titanium plates and screws, orthodontic brackets and metal foreign bodies. Four hundred metal artifact CT data and 1 000 artifact-free CT data were utilized for simulation synthesis, and 1 000 pairs of simulated artifacts and metal images and simulated metal images (200 pairs of each type) were constructed. Under the condition that the data of the five metal artifacts were equal, the entire data set was randomly (computer random) divided into a training set (800 pairs) and a test set (200 pairs). The former was used to train the GAN model, and the latter was used to evaluate the performance of the GAN model. The test set was evaluated quantitatively and the quantitative indexes were root-mean-square error (RMSE) and structural similarity index measure (SSIM). The trained GAN model was employed to eliminate the metal artifacts from the CT data of the remaining 220 clinical cases of metal artifact CT data, and the elimination results were evaluated by two senior attending doctors using the modified LiKert scale. Results: The RMSE values for artifact elimination of fillings, crowns, titanium plates and screws, orthodontic brackets and metal foreign bodies in test set were 0.018±0.004, 0.023±0.007, 0.015±0.003, 0.019±0.004, 0.024±0.008, respectively (F=1.29, P=0.274). The SSIM values were 0.963±0.023, 0.961±0.023, 0.965±0.013, 0.958±0.022, 0.957±0.026, respectively (F=2.22, P=0.069). The intra-group correlation coefficient of 2 evaluators was 0.972. For 220 clinical cases, the overall score of the modified LiKert scale was (3.73±1.13), indicating a satisfactory performance. The scores of modified LiKert scale for fillings, crowns, titanium plates and screws, orthodontic brackets and metal foreign bodies were (3.68±1.13), (3.67±1.16), (3.97±1.03), (3.83±1.14), (3.33±1.12), respectively (F=1.44, P=0.145). Conclusions: The metal artifact reduction GAN model constructed in this study can effectively remove the interference of metal artifacts and improve the image quality.

Syndesmotic Suture Button Fixation Results in Higher Tegner Activity Scale Scores When Compared to Screw Fixation: A Multicenter Investigation.

Suture buttons and metal screws have been used and compared in biomechanical, radiographic, and clinical outcome studies for syndesmotic injuries, with neither implant demonstrating clear superiority. The aim of this study was to compare clinical outcomes of both implants. Patients who underwent syndesmosis fixation at 2 separate academic centers from 2010 through 2017 were compared. Thirty-one patients treated with a suture button and 21 patients treated with screws were included. Patients in each group were matched by age, sex, and Orthopaedic Trauma Association fracture classification. Tegner Activity Scale (TAS), Foot and Ankle Ability Measure (FAAM), patient satisfaction score, surgical failure, and reoperation rates were compared. Patients who underwent suture button fixation had significantly higher TAS scores than those who underwent screw fixation (p < 0.001). There was no significant difference in FAAM ADL scores between cohorts (p = 0.08). Symptomatic hardware removal rates were similar (3.2% suture button cohort vs 9.0% in screw cohort). One patient (4.5%) underwent revision surgery secondary to syndesmotic malreduction after screw fixation, for a reoperation rate of 13.5%. Patients with unstable syndesmotic injuries treated with suture button fixation had higher mean TAS scores compared to patients treated with screws. Foot and Ankle Ability Measure and ADL scores in these cohorts were similar.Level of Evidence: Level 3 Retrospective Matched Case-Cohort.

МОДЕЛЮВАННЯ НАПРУЖЕНО-ДЕФОРМОВАНОГО СТАНУ ТОНКОСТІННИХ КУПОЛІВ З ПОЛІКАРБОНАТУ ДЛЯ РАЦІОНАЛЬНОГО ПРОЕКТУВАННЯ

The paper contains the further developed of method for calculating thin-walled dome systemswithout a stationary foundation. Have been carried out the detailed analysis of the fundamental design solutions for frameless collapsible spherical polycarbonate domes, which are used by modern world manufacturers of these structures. Have been done a brief description of the momentless theory of the operation of spherical shells, which is adapted for polycarbonate domes. Have been considered a simplified analytical model of the stress-strain state of a spherical shell with an equatorial diameter of up to5 m under the influence of climatic influences for the subsequent verification of detailed models. Have been developed highly detailed finite element models of domes of different sizes, taking into account technological openings and structural stiffeners (support ring and door frame) under the wind, snow, ice loads and under other climatic influences. Have been identified the fragments with the highest stresses from various loads and forms of the deformation of the structure.Have been considered separately the issues related to the loss of shape stability, position and balance of a thin-walled spherical shell, as a light temporary structure. Have been proven that the worst influence on the dome structures is the windinfluence, based on the stability criterion. Have been determined the estimated value of the aerodynamic lifting force from wind effects on the dome. Have been proven that the lifting force far exceeds the stabilizing force of the weight of a thin-walled dome. Have been revealed with the help of the performed calculations, it was that a frameless spherical polycarbonate dome inevitably БУДІВЕЛЬНІ КОНСТРУКЦІЇНАУКОВО-ТЕХНІЧНИЙ ЖУРНАЛ “СУЧАСНІ ТЕХНОЛОГІЇ, МАТЕРІАЛИ І КОНСТРУКЦІЇ В БУДІВНИЦТВІ”84loses its balance stability due to the action of wind loads and requires unfastening with anchors. Have been proposed a rational method for anchoring dome structures at temporary earthen construction sites using geo-screws or metal screw piles. Have been revealed the addiction between the radius of curvature of a spherical dome and the rational thickness of polycarbonate based on the criteria of stiffness and strength. Have been formulated the constructive recommendations regarding the rational design of polycarbonate dome systems. Have been developed the technological regulations for the further safe operation of domes, and have been outlined the directions for further scientific research on this topic

Open Latarjet with Metal-Free Cerclage Fixation

Despite multiple modifications, the Latarjet is still the most popular procedure for recurrent anterior shoulder instability with glenoid bone loss. Partial or subtotal resorption of the graft is common, potentially leading to hardware prominence and risk of anterior soft-tissue impingement. To minimize the technical difficulties and morbidity associated with metallic implants, a coracoid and conjoint tendon transfer with a mini-open approach using Cerclage tape suture is described, as an alternative for the Latarjet procedure typically performed with metal screws and plates.

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

BackgroundAllograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union.Patients and methodsWe retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union.ResultsUsing the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate.ConclusionUsing the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars.Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

Optimization of the Manufacturing Process and Mechanical Evaluation of a Functionally Graded Biodegradable Composite Screw for Orthopedic Applications.

Metal screws are commonly used for fracture fixations. However, the high modulus of elasticity relative to bones and releasing metallic ions by the metal screw needed a second surgery to remove the implant after the healing period. Furthermore, the removal of metal screws following the healing of the bone is a serious problem that can lead to refracture due to the presence of holes in the screw. Bioresorbable screws can overcome most of the problems associated with metallic screws which motivated research on manufacturing nonmetallic screws. In this study, three-layer poly L-lactic acid/bioactive glass composite screws were manufactured according to functionally graded material theory, by the forging process. All of the physical and chemical parameters in the manufacturing stages from making composite layers to the forging process were optimized to obtain suitable mechanical properties and durability off the screw in load-bearing positions. The tri-layer composite screw with unidirectional, ±20° angled, and random fibers orientation from core to shell shows a flexural load of 661.5 ± 20.3 (N) with a decrease about 31% after 4-week degradation. Furthermore, its pull-out force was 1.8 ± 0.1 (N) which is considerably more than the degradable polymeric screws. Moreover, the integrity of the composite screws was maintained during the degradation process. By optimizing the manufacturing process and composition of the composite and crystallinity, mechanical properties (flexural, torsion, and pull-out) were improved and making it a perfect candidate for load-bearing applications in orthopedic implants. Improving the fiber/matrix interface through the use of a coupling agent was also considered to preserve the initial mechanical properties. The manufactured screw is sufficiently robust enough to replace metals for orthopedic load-bearing applications.

Low-frequency vibration of a timber joist floor section connected by metal screws: experimental validation of FEM models

The structural dynamics of a timber floor junction (six pieces of chipboard plate screwed to a single timber joist) have been investigated experimentally in a frequency range up to 200Hz. Experimental Modal Analysis (EMA), transfer mobilities and velocity level ratios between the chipboard walking surface and the joist were measured with 12 or 24 screw connections between the joist and the chipboard. These experimental data were used to validate Finite Element (FE) models that focussed on the interaction between the chipboard and the joist due to the screws. The aim is to develop validated FE models for timber floors that can be used to assess heavy impacts (such as the rubber ball impact source) and act as a reference for the future development of TSEA models for lightweight structures. The screws were modelled using both rigid connections and springs. For the latter, each point connection was modelled by four springs with stiffness (three coordinate directions and one rotational direction), with model updating using a Deep Neural Network (DNN). A comparison of mode frequencies and mode shapes from EMA and FEM will be made along with forced vibration of the structure.

Clinical outcomes of an olive wire and external fixator versus a metallic screw in the treatment of inferior tibiofibular syndesmosis injuries in ankle fractures

BackgroundMetal screws are the most widely used in treating syndesmotic injuries, but failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We have provided an alternative with an olive wire and external fixator(OWEF) used for syndesmotic fixation. MethodsA retrospective longitudinal follow-up study was conducted. From February 2011 to January 2018, 58 of 72 patients with ankle fractures and associated syndesmotic disruption were treated with either screw or OWEF fixation. The costs, complications, and clinical outcomes using Olerud-Molander score and Visual Analog score in screw and OWEF fixation group were compared. ResultsWe found the severity of the injury, BMI of the patients and the different fixation methods were determinants of the complications and clinical outcomes. But if no malreduction of the syndesmosis was present, no difference in clinical result was detected. ConclusionThe OWEF method appeared to be at least equally functional and effective to screw fixation while maintaining possible lower complication rate. Levels of clinical evidenceLevel 3

Biomechanical comparison of Tibial-sided supplemental fixation techniques in Bone-Patellar Tendon-Bone anterior cruciate ligament reconstruction

PurposeThe purpose of this study was to compare the biomechanical properties of a commercially available suture anchor and a screw post for supplemental tibial fixation of a bone-patellar tendon-bone (BTB) graft at time zero. We hypothesized that supplemental fixation using a suture anchor would demonstrate similar biomechanical performance in comparison with a screw post. MethodsSixteen fresh frozen, healthy human cadaveric knees underwent BTB autograft harvest, placement, and primary tibial-sided interference screw fixation using a standardized technique performed by a single surgeon. Specimens were randomly assigned to one of two tibial-sided supplemental fixation groups (suture anchor or screw post), yielding eight specimens in each group. Each specimen was affixed to a custom loading apparatus, with the tibial tunnel aligned in a vertical position that allowed for parallel “worst-case scenario” loading and eliminated loading variation due to tibial tunnel angle. Grafts were pretensioned to 30 N and biomechanical performance was compared with respect to cyclical loading between 50–250 N for 500 cycles at 0.5 Hz and pull-to-failure loading at 60 mm/min. ResultsThe suture anchor and screw post supplemental constructs demonstrated similar performance with respect to all biomechanical parameters assessed, including yield strength (294.0 N [IQR 267.2–304.2 N] versus 332.1 N [IQR 313.8–350.4 N]; P = 0.079) and ultimate strength (330.1 N [IQR 306.9–418.7 N] versus 374.7 N [IQR 362.0–387.3 N]; P = 0.3798). However, of the eight original specimens in each group, one suture anchor specimen (12.5%) and six metallic screw post specimens (75%) failed during cyclical testing and were unable to undergo displacement and load to failure testing. ConclusionThis study provides preliminary evidence that supplemental tibial-sided fixation of a BTB ACL graft with a suture anchor has similar loading characteristics or load-to-failure strength when compared to supplemental fixation with a screw post construct. Study designLaboratory Controlled Study. Level of evidenceBasic Science Study.

Application of metal artifact reduction algorithm in reducing metal artifacts in post-surgery pediatric low radiation dose spine computed tomography (CT) images.

The commonly used methods for removing metal-induced beam hardening artifacts often rely on the use of high energy photons with either high tube voltage or high energy virtual monoenergetic images in dual-energy computed tomography (CT), the radiation dose was usually relatively high in order to generate adequate signals. This retrospective study is designed to evaluate the application of a metal artifact reduction (MAR) algorithm in reducing pedicle screw metal-caused beam hardening artifacts in post-surgery pediatric low radiation dose spine CT images. Seventy-seven children (3-15 years) who had undergone a low dose CT with 140 or 100 kV were enrolled. The radiation dose was 1.40 mGy for the 3-8 years old and 2.61 mGy for 9-15 years old children. There were 116 pedicle screws evaluated. The raw data were reconstructed with adaptive statistical iterative reconstruction-V (ASIR-V) at 50% strength, ASIR-V with MAR (AV-MAR), deep learning image reconstruction (DLIR) at high strength and DLIR with MAR (DL-MAR). The image quality concerning pedicle screws was evaluated objectively in terms of the length of beam-hardening artifact (LHA) and artifact index (AI), and subjectively using a 4-point scale (4 points: best, 3 points: acceptable). Both AV-MAR and DL-MAR significantly reduced metal-induced beam hardening artifacts with smaller LHA (15.76±10.12 mm, a reduction of 57.24% and 15.66±10.49 mm, a reduction of 57.40%, respectively), and AI value (62.50±33.51, a reduction of 64.65% and 61.03±32.61, a reduction of 65.01%, respectively) compared to ASIR-V and DLIR (all P<0.01), The subjective image quality scores concerning the screws were 3.37±0.49 and 3.47±0.50 with AV-MAR and DL-MAR, respectively, higher than the respective value of 1.73±0.44 and 1.76±0.43 without MAR (all P<0.01). MAR significantly reduces the low-density artifacts caused by metal screws in post-surgery pediatric low-dose spine CT images, across different tube voltages, radiation dose levels and reconstruction algorithms. Combining DL-MAR further improves the overall image quality under low radiation dose conditions.

Foreign Object Debris (FOD) Classification Through Material Recognition Using Deep Convolutional Neural Network With Focus on Metal

Foreign object debris (FOD) is any undesired and unintended object placed or found in the specific vicinity of an aircraft (runway/ taxiway) that can cause damage to aircraft or harm personnel on board such as twisted metal strips, screws, nuts, and bolts, depleted concrete runway pieces, stones, pebbles and stationery items. To avoid FOD damages, all airport/ aviation organizations have deployed some sort of FOD prevention procedure. However, automatic FOD detection systems are still scarce owing to the inevitable reliance on human experts that lead to unavoidable human errors. Around 60% of FOD consists of metal which is the most deteriorating for an aircraft. Therefore, the implementation of material recognition techniques for FOD classification through Deep Convolutional Neural Networks (DCNN) is more important than FOD object detection as FOD could be of any shape, size or color. This paper developed a DCNN algorithm for FOD material classification with high accuracy for all included material classes (i.e., metal, concrete, plastic) in general and metal in particular. For this, a new dataset is introduced that consists of 2481 images taken on an operational airport runway in varying illumination and weather conditions. Through extensive testing, it was found that InceptionV3 is the best performing model with 18% improvement in metal recognition, and 11% improvement in average accuracy for all included classes.

A study of functional outcome in patients undergoing arthroscopic reconstruction of anterior cruciate ligament injury using hamstring tendon graft with interference screws

The Anterior Cruciate Ligament is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting the rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion and easier rehabilitation. Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Materials and Methods: Patients admitted to CG hospital and Bapuji hospital in Davangere, Karnataka between 2019 October to 2021 October were taken into the study after taking informed consent. Results: This study consists of 25 cases of Anterior Cruciate Ligament injury. All cases were performed arthroscopically. ACL rupture was common in second and third decade. In our study, male preponderance was found with 23 (92%) and female preponderance of 2 (8%). Side affected was 13 (52%) right side and 12 (48%) left side. Mode of injury in the present study includes various sources such as sports, RTA, fall. Results were evaluated by using International Knee Documentation committee (IKDC) and Lysholm knee scoring scale. In present study we have 22 patients with Excellent results, 2 cases as Good, 1 case as Fair and 0 cases as Poor. No case needed re-surgery. In the present study there were no cases of superficial infection. Conclusion: Arthroscopic reconstruction of ACL using Semitendinous and Gracilis tendon graft (Hamstring tendon) with Interference screws can be considered the best mode of treatment for ACL rupture.

Modified Reconstruction of The Proximal Tibiofibular Joint Using Iliotibial Band: A Case Report

Introduction: Instability of the proximal tibiofibular joint is a rare condition and may present with an atypical presentation due to its location and symptoms. Recent techniques and graft has allowed to repair tibiofibular joint. Iliotibial band autograft might be used as a choice for this case as its characteristic, cost effectiveness, minimal invasive graft harvesting procedure, and long term outcome bring consideration to use as choice for the treatment. Objective: To introduce the new technique for PTFJ instability by using ITB graft Case report: A 21-year-old office worker male came to our clinic with discomfort on lateral aspect of right knee. He injured his right knee after he externally twist his right knee when he was going to wake up (stand up) from bed. He experienced immediate lateral pain and swelling lateral knee pain persisted until 1 week before admitted to the hospital. Discussion: In our case, patient is a office worker without an adequate energy cause the joint becoming sublux. For the surgical technique , we took the graft form the center side of ITB with the intentional purpose of preventing Kaplan Fiber. For the reaming procedure we took place directly behind the fibula and keep the posterior capsule intact to prevent further damage and infection on surgical site. We choose to use biomaterial implant for this study because the use of biomaterial screw itself has a low complication rate compare to metallic screw with no significant different in outcome (6). This technique overall has a satisfaction result with improvement of Lyshom score Conclusion: Iliotibial band is an alternative graft that can be used for reconstruction in tibiofibular joint. For its minimal invasive technique and cost effectiveness and satisfy long term outcome coud be a consideration for the treatment in tibiofibular instability.

The “BioHumi" Humeral Head Osteochondral Allograft Transplantation for Reverse Hill-Sachs Lesion of the Shoulder

Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the “BioHumi” technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft.

Foreign body ingestion: Is intervention always a necessity?

Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval. We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition. A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation. Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.

Weight-Bearing CT Hounsfield Unit Algorithm Assessment of Calcaneal Osteotomy Healing: A Prospective Study Comparing Metallic and Bio-Integrative Screws

Category: Basic Sciences/Biologics; Hindfoot; Other Introduction/Purpose: The use of bio-integrative implants in orthopedic surgery is growing rapidly. While many biomechanical and histological studies have been able to demonstrate their structural and biological properties, few clinical reports are available to support their advantages, such as good osteosynthesis, lower rates of removal, and diminished implant-related artifact in imaging studies. This clinical information is vital to providers when choosing the proper material and planning postoperative treatment. Hounsfield Units (HU) algorithms have been used as an objective assessment of joint space width. This pilot data analysis intends to test the capacity of the bio-integrative screws in reaching similar radiographical outcomes of the current metallic screws when analyzing medial displacement calcaneus osteotomies (MDCO). Our hypothesis is that both types of implants would present similar results. Methods: In this prospective comparative IRB-approved study, three patients undergoing MDCO with bio-integrative screws were compared to two patients undergoing the same surgery with metallic screws. Surgeon, primary diagnosis, technique, and displacement were the same for both groups. Patients were assessed using weight-bearing computed tomography at weeks 2, 6, and 12 postoperatively. Using a dedicated software, a 40x40x40mm cube, which defines a volume of interest (VOI), is centered at the osteotomy site. Within the VOI, initial computational analysis focused on image intensity (Hounsfield Units) profiles along lines perpendicular to the osteotomy line, crossing the osteotomy line and spanning approximately 8mm on either side. The HU intensity profiles were recorded, and graphical plots of the HU distributions were generated for each line. The plots were then used to calculate the HU contrast, a proxy for bone healing at the osteotomy site. Results: At 2 weeks, mean HU intensity in the metallic and bio-integrative were respectively 403.25 and 416.28 at the centerline (p=0.312), 513.24 and 386.57 at the inferior (p&lt;0.001), 438.97 and 487.92 at the superior line (p=0.020). With 6 weeks, a mean HU intensity of 318.40 and 414.22 was observed at the centerline (p&lt;0.001), 340.41 to 356.86 (p=0.315) at the inferior, and 401.72 and 449.88 at the superior (p=0.018). At 12 weeks, HU intensity of -85.01 and 64.59 was found at the center (p&lt;0.001), - 111.36 and 139.19 at the inferior (p&lt;0.001), and 225.95 and 166.05 at the superior line respectively (p=0.010). Overall HU units decrease from the second to the twelfth week in both groups (ps&lt;0.001). The contrast was higher in the metallic patients (0.66 to 0.26). Conclusion: Comparison among bone healing between metallic and bio-integrative screws through HU algorithms found similar results. The absence of valleys on the HU graphical plots at 2 weeks postoperatively could be a direct sign of osteotomy compression. Diffuse osteopenia might explain lower amounts at the 12-week evaluation. Maximum HU values were similar, indicating equivalent results at the osteotomy sites, a finding compatible with consolidation. Presence of metallic implants across the osteotomy site hindered both HU intensity and contrast evaluation, presenting a challenge when calculating bone healing through indirect and direct assessments.