Comparison and prediction of pullout strength of conical and cylindrical pedicle screws within synthetic bone

<p>Abstract</p> <p>Background</p> <p>This study was designed to derive the theoretical formulae to predict the pullout strength of pedicle screws with an inconstant outer and/or inner diameter distribution (conical screws). For the transpedicular fixation, one of the failure modes is the screw loosening from the vertebral bone. Hence, various kinds of pedicle screws have been evaluated to measure the pullout strength using synthetic and cadaveric bone as specimens. In the literature, the Chapman's formula has been widely proposed to predict the pullout strength of screws with constant outer and inner diameters (cylindrical screws).</p> <p>Methods</p> <p>This study formulated the pullout strength of the conical and cylindrical screws as the functions of material, screw, and surgery factors. The predicted pullout strength of each screw was compared to the experimentally measured data. Synthetic bones were used to standardize the material properties of the specimen and provide observation of the loosening mechanism of the bone/screw construct.</p> <p>Results</p> <p>The predicted data from the new formulae were better correlated with the mean pullout strength of both the cylindrical and conical screws within an average error of 5.0% and <it>R</it>²= 0.93. On the other hand, the average error and <it>R</it>²value of the literature formula were as high as -32.3% and -0.26, respectively.</p> <p>Conclusion</p> <p>The pullout strength of the pedicle screws was the functions of bone strength, screw design, and pilot hole. The close correlation between the measured and predicted pullout strength validated the value of the new formulae, so as avoid repeating experimental tests.</p

Prediction of default probability for construction firms using the logit model

Recently, the high incidence of construction firm bankruptcies has underlined the importance of forecasting defaults in the construction industry. Early warning systems need to be developed to prevent or avert contractor default; additionally, this evaluation result could facilitate the selection of firms as collaboration or investment partners. Financial statements are considered one of the key basic evaluation tools for demonstrating firm strength. This investigation provides a framework for assessing the probability of construction contractor default based on financial ratios by using the Logit model. A total of 21 ratios, gathered into five financial groups, are utilized to perform univariate logit analysis and multivariate logit analysis for assessing contractor default probability. The empirical results indicate that using multivariate analysis by adding market factor to the liquidity, leverage, activity and profitability factors can increase the accuracy of default prediction more than using only four financial factors. While considering the market factor in the multivariate Logit model, clear incremental prediction performance appears in 1-year evaluation. This study thus suggests that the market factor comprises important information to increase the prediction performance of the model when applied to construction contractors, particularly in short-term evaluation

Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire

<p>Abstract</p> <p>Background</p> <p>In our institution, the fixation technique in treating idiopathic scoliosis was shifted from hybrid fixation to the all-screw method beginning in 2000. We conducted this study to assess the intermediate -term outcome of all-screw method in treating adolescent idiopathic scoliosis (AIS).</p> <p>Methods</p> <p>Forty-nine consecutive patients were retrospectively included with minimum of 5-year follow-up (mean, 6.1; range, 5.1-7.3 years). The average age of surgery was 18.5 ± 5.0 years. We assessed radiographic measurements at preoperative (Preop), postoperative (PO) and final follow-up (FFU) period. Curve correction rate, correction loss rate, complications, accuracy of pedicle screws and SF-36 scores were analyzed.</p> <p>Results</p> <p>The average major curve was corrected from 58.0 ± 13.0° Preop to 16.0 ± 9.0° PO(<it>p </it>< 0.0001), and increased to 18.4 ± 8.6°(<it>p </it>= 0.12) FFU. This revealed a 72.7% correction rate and a correction loss of 2.4° (3.92%). The thoracic kyphosis decreased little at FFU (22 ± 12° to 20 ± 6°, (<it>p </it>= 0.25)). Apical vertebral rotation decreased from 2.1 ± 0.8 PreOP to 0.8 ± 0.8 at FFU (Nash-Moe grading, <it>p </it>< 0.01). Among total 831 pedicle screws, 56 (6.7%) were found to be malpositioned. Compared with 2069 age-matched Taiwanese, SF-36 scores showed inferior result in 2 variables: physical function and role physical.</p> <p>Conclusion</p> <p>Follow-up more than 5 years, the authors suggest that all-screw method is an efficient and safe method.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mechanical Performance of the New Posterior Spinal Implant: Effect of Materials, Connecting Plate, and Pedicle Screw Design

Study Design. A newly designed spinal implant was tested to evaluate multicycle stiffness and fatigue resistance. Objectives. To investigate the effect of different materials , connecting plate, and pedicle screw design on the mechanical performance of the spinal implant. Summary of the Background Data. The addition of cross-linkages did not significantly increase implant compression/flexion stiffness , but accelerated fatigue failure at the rod junctions. Both Ti-6Al-4V spinal implants and the 316L stainless-steel counterparts have been used extensively for clinical cases ; however, design factors establishing the proposed superiority of the Ti- 6Al-4V implant for fatigue resistance have not, as yet, been extensively studied. Methods. Twenty implants with connecting plates ( two materials by two screw designs by five implants) and five implants without connecting plates were assembled to UHMWPE blocks and cyclically loaded from 60 N to 600 N at a frequency of 5 Hz. Results. Failure sites for the tested prototypes were at the cephalic screw hubs or rod-plate junctions. All Ti6Al-4V implants demonstrated reduced stiffness compared to the structurally identical 316L analogs. The use of connecting plates raised the stiffness of the 316L prototypes without cross-links. However, elimination of the connecting plate avoided stress concentration at the rod/plate junctions and increased fatigue life. The Ti-6Al-4V new system with the minimal notch effect at the screw hubs achieved greater fatigue resistance than its 316L counterpart. By contrast, enlargement of the inner-hub diameter resulted in greater gains for fatigue resistance than for stiffness, especially for Ti-6Al-4V variants. Conclusions. Although Ti -6Al-4V was superior to 316L for endurance-limit properties, structural design of the Ti-6Al-4V implant dramatically affects fatigue resistance. This may explain the differences between existing studies and the current report, comparing fatigue life forimplantsmade from these two materials. Our results reveal that Ti-6Al-4V must be carefully treated because of sensitivity to notch, with special consideration given to screw-hub design