Biomechanical measurements of cortical screw stripping torque in human versus artificial femurs

Femur fracture plates are applied using cortical bone screws. Surgeons do this manually by subjective ‘feel’ without monitoring torque. Few studies have quantified stripping torque in human bone. No studies have measured stripping torque in the artificial bones from Sawbones (Vashon, WA, USA) that are frequently used in biomechanical studies. The present aim was to measure stripping torque of cortical screws in human versus artificial femurs. Sixteen fresh-frozen human femurs and eight artificial femurs were used. Using a digital torque screwdriver, each femur had a 3.5-mm diameter unicortical screw manually inserted into the anterior midshaft until failure of the screw–bone interface. Results were normalized by cortical thickness and the screw–bone interfacial area. There were no statistical differences in human versus artificial data, respectively, for stripping torque (1741 ± 442 N.mm, 2012 ± 176 N.mm, p = 0.11), stripping torque/thickness (313 ± 59 N, 305 ± 30 N, p = 0.74), and stripping torque/area (28.5 ± 5.3 N/mm, 27.8 ± 2.8 N/mm, p = 0.74). Artificial unicortical thickness (6.6 ± 0.3 mm) was greater than human thickness (5.6 ± 1.1 mm) (p = 0.02). For human specimens, there was a moderate linear correlation of absolute and normalized stripping torque versus standardized bone mineral density (R ≥ 0.32) and clinical T-score (R = 0.29), but not with age (R ≤ 0.29). Surgeons should be aware of the stripping torque limits for human femurs and potentially take steps to monitor these values during surgery. The artificial femurs being increasingly used in research accurately replicate human cortical properties during screw insertion. To date, this is the first series of human femurs evaluated for cortical screw stripping.