title: Effect of Real-Time Feedback on Screw Placement Into Synthetic Cancellous Bone.
abstract: OBJECTIVE
  The objective of this study is to evaluate whether real-time torque feedback may reduce the occurrence of stripping when inserting nonlocking screws through fracture plates into synthetic cancellous bone.
  
  
  METHODS
  Five attending orthopaedic surgeons and 5 senior level orthopaedic residents inserted 8 screws in each phase. In phase I, screws were inserted without feedback simulating conventional techniques. In phase II, screws were driven with visual torque feedback. In phase III, screws were again inserted with conventional techniques. Comparison of these 3 phases with respect to screw insertion torque, surgeon rank, and perception of stripping was used to establish the effects of feedback.
  
  
  RESULTS
  Seventy-three of 239 screws resulted in stripping. During the first phase, no feedback was provided and the overall strip rate was 41.8%; this decreased to 15% with visual feedback (P < 0.001) and returned to 35% when repeated without feedback. With feedback, a lower average torque was applied over a narrower torque distribution. Residents stripped 40.8% of screws compared with 20.2% for attending surgeons. Surgeons were poor at perceiving whether they stripped.
  
  
  CONCLUSIONS
  Prevention and identification of stripping is influenced by surgeon perception of tactile sensation. This is significantly improved with utilization of real-time visual feedback of a torque versus roll curve. This concept of real-time feedback seems beneficial toward performance in synthetic cancellous bone and may lead to improved fixation in cancellous bone in a surgical setting.
authors.affiliation: *Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI; and †Department of Orthopaedic Surgery, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Gustafson
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Geeslin
authors.forename: David M
authors.initials: DM
authors.lastname: Prior
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chess
mesh_terms: D040761:Biomimetic Materials / Q000737:chemistry*; D001863:Bone Screws; D018786:Bone Substitutes; D005246:Feedback; D006801:Humans; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013647:Task Performance and Analysis; D019415:Torque
chemical_list: D018786:Bone Substitutes