Biomedical subjects

W C Hayes

Publications and source records attributed to W C Hayes.

At least 19 recordsLinked to original sources

PubMed1992

Mechanical properties of trabecular bone within and adjacent to osseous metastases.

Despite radiographic and histologic evidence of trabecular bone density changes within and adjacent to osseous metastases, there currently exist no data to demonstrate whether these changes are important in predicting the risk of fracture. To determine if these density changes result in significant reductions in mechanical properties, trabecular bone specimens were prepared from lower thoracic and lumbar vertebrae from two cadavers with radiographic, gross, and histologic evidence of lytic and/or blastic osseous metastases. Each specimen was classified as normal, lytic, or blastic based on appearance in fine-grain radiographs of 8-9 mm thick coronal plane sections. Specimens were tested to failure in uniaxial compression, and tissue and apparent densities were measured. Mean tissue densities were within normal ranges. The mean apparent density for all specimens combined was within the normal range for human vertebrae, and the mean apparent density for radiographically normal (0.131 g/ml) and lytic (0.111 g/ml) specimens was less than the mean apparent density of blastic (0.182 g/ml) specimens (p < 0.02). The moduli of lytic and blastic specimens were less than for normal specimens (p < 0.025). The strength of lytic specimens was less than normal (p = 0.057), but the strength of blastic specimens was not (p > 0.1). Apparent density explained significant fractions of the variations in both modulus (p < 0.001) and strength (p < 0.001). The data suggest that blastic changes associated with osseous metastases to trabecular bone disrupt the normal dependence of trabecular mechanical properties on apparent density, but lytic changes do not.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

Effects of 4-amino-1-hydroxybutylidene bisphosphonate on bone biomechanics in rats.

Bisphosphonates inhibit osteoclast-mediated bone resorption, but their effects on the mechanical behavior of bone remain uncertain. This study investigated the effects of 4-amino-1-hydroxybutylidene bisphosphonate (AHBuBP) on the biomechanical and morphologic properties of bone in ovariectomized rats. Sprague-Dawley rats (four groups, n = 6) were ovariectomized at 3 months of age. From 7 to 13 months, the groups received vehicle or 0.28, 2.8, or 28 micrograms/kg of AHBuBP twice weekly through subcutaneous injection. An additional group of control animals (n = 6) received neither surgery nor drug. We determined the stiffness, yield, and ultimate loads of the femoral midshaft, the sixth lumbar (L6) vertebra, and the femoral neck. Geometric properties of the cortical bone were measured from digitized images of the tibial diaphysis at the level of the synostosis. The area fraction of trabecular bone was determined through the midsagittal plane of the fifth lumbar (L5) vertebra. There were no significant differences in the structural properties of the femoral neck and midshaft, with the exception that the medium-dose group had a greater ultimate load than the vehicle group for the femoral midshaft in bending. Cross-sectional analysis of the tibia did not show significant differences in the inertial properties or area. Ovariectomy caused a significant reduction in the stiffness and ultimate load of L6 and in the area fraction of trabecular bone of L5.(ABSTRACT TRUNCATED AT 250 WORDS)

Alendronate↗

PubMed1992

Role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty.

The objective of this study was to establish the role of loads and prosthesis material properties on the mechanics of the proximal femur after total hip arthroplasty. We developed a three-dimensional finite element model of an intact human femur and the same femur with a conventional collared straight-stem femoral component. Using published data, we defined two sets of loading conditions: one that represented three phases of gait, and one that represented four different extreme loads. The four extreme loads were based on the peak joint contact forces that occur during stair ascent and isometric contraction of various muscle groups. The model was analyzed with three different material properties for the prosthesis, including cobalt-chromium alloy, titanium alloy, and a carbon fiber-reinforced polymer (CFRP) laminate. We assumed that the implant was stable, with rigid bonding, collar contact, and no cement. To address femoral component loosening, we examined the shear stresses at the implant-bone interface; to address adaptive bone remodeling, we examined the principal stresses in the supporting cortical bone relative to those in the intact femur. Our analyses of the various loading conditions demonstrated large out-of-plane bending movements and torsional moments, especially for the load representing stair ascent. Based on stepwise multiple regressions, the maximum shear stresses at the implant-bone interface in the distal region were dependent on the total applied axial force and torsion; the maximum shear stresses in the proximal region were dependent on the axial component of the joint contact force alone. Reduction in the prosthesis stiffness, by substitution of the CFRP material properties, resulted in lower interface shear stresses at the distal end of the stem and higher interface shear stresses at the more proximal sections, consistent with the findings of others. We fit equations, based on composite beam theory, to the maximum implant-bone interface shear stresses and the cortical bone principal stresses as a function of the axial modulus of the prosthesis. These equations can be used to estimate the maximum stresses at the interface and in the cortical bone that would be predicted by similar models, for the same prosthesis constructed of alternative materials, relative to the stresses in the intact femur. The nonlinear nature of these relationships was such that the cortical bone stresses changed more rapidly, as a function of the prosthesis modulus, for lower values of elastic modulus, especially in the more proximal sections.

Biomechanical Phenomena↗

PubMed1992

In vitro hyperextension injuries in the human cadaveric cervical spine.

To investigate the relationship between the type of hyperextension injuries and the conditions producing them, nine cervical specimens (occiput to T1) were loaded to failure in tension at a fixed extension angle of 30 degrees. Under these loading conditions, specimens failed at average tensile loads and extension moments of 499 +/- 148 (SD) N and 4.0 +/- 3.1 Nm, respectively. Failure occurred at an average tensile displacement of 18.8 +/- 7.7 mm. The anterior longitudinal ligament ruptured and the intervertebral disc failed in at least one level in all specimens. In four specimens, the disc failed at an additional level, leaving the anterior longitudinal ligament intact at that site. With one exception, all injuries occurred in the lower cervical spine (C5-C6 and C6-C7), the region most often injured in vivo. The location of the injuries was associated with the degree of degeneration of the facet joints and the discs. The discs of the lower cervical spine were significantly more degenerated than those at the C2-C3 level. In addition, the degree of disc degeneration in the noninjured discs was significantly less than in the injured discs. These data help quantify the threshold of injury and the patterns of tissue damage resulting from hypertension loading of the cervical spine.

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PubMed1992

Finite element stress analysis of simulated metastatic lesions in the lumbar vertebral body.

A three-dimensional finite element model of a lumbar vertebral body was developed to study the effects of geometry, material properties and loading conditions on stresses in the presence of metastatic lesions. Parameters studied included location and size of the lesion, modulus of the cortical and trabecular bone within and near the lesion, generalized osteoporosis and load distribution. The results, expressed as ratios of peak values of displacement and stress, relative to a normal baseline case, indicated that the location of a defect which did not penetrate the cortex had a minor influence on the peak displacement and stresses, as did the presence of lesions occupying less than 40% of the volume of the vertebral centrum. A lesion occupying 40% of the centrum volume increased the endplate displacement by 2.9 times, the peak tensile stress in the cortical shell by 2.2 times, and the peak von Mises stress in the endplate by 2.8 times. When this lesion penetrated the cortex, these values increased to 3.8, 3.3 and 4.4 times, respectively. The most severe case involved a defect penetrating the anterior cortex, osteoporotic bone properties and anteriorly eccentric loading. In this case, the peak values increased to 8.4, 3.4 and 5.9 times their baseline values, respectively. The results are consistent with a model of the vertebral body as a stiff frame of cortical bone surrounding a relatively compliant core of trabecular bone. Only variations in geometry and properties large enough to lessen significantly the structural stiffness affect the peak stresses and displacements.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1992

A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model.

Clinical failures of internal fixation implants for the treatment of the thoracolumbar spine are generally attributed to fatigue. Few studies, however, have characterized changes in fixation rigidity with time or subjected spine-implant fixation constructs to fatigue loading until failure. Fatigue characteristics of five dorsally applied spinal fixation implants were determined using lumbosacral calf spines, with an L3 vertebrectomy, loaded cyclically in combined compression (maximum 605 N) and flexion (maximum 16 Nm) for up to 100,000 cycles. Displacement transducers monitored motion at the site of instability and at the segment above the implants. Flexibility and strain at these segments were then calculated. A one-way analysis of variance showed that there were no significant differences in flexibility of the five fixation constructs (P greater than .05). A multiple Bonferroni test revealed that the AO and Kluger fixateur interne and Steffee plates, with fixation at L2 and L4, allowed significantly more strain (P less than .01) across the site of instability than did Harrington rods and Luque plates with fixation at L1, L2, L4, and L5. There were no significant differences between fixation constructs in initial strain above the implants. After 10,000 cycles, however, there were significant increases in strain across the segment above the Luque and Harrington implants (P less than .05). Failure of the AO Schanz screw occurred in three of six constructs at a mean of 73,300 cycles. The Steffee screws failed in four of five constructs at a mean of 20,800 cycles. The rods of the Kluger fixateur interne broke in four of five constructs at a mean of 47,800 cycles, and one screw slipped at 11,000 cycles. There were no metal failures in the Harrington or Luque implants.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Holding power and reinforcement of cancellous screws in human bone.

The authors report an in vitro biomechanical evaluation of a biodegradable material that might be used for the reinforcement of surgical screws in fractures involving severely osteoporotic bone. The material is a particulate composite with a matrix phase consisting of a hydrolyzable prepolymer, polypropylene fumarate (PPF), crosslinked with methacrylate monomer, and a particulate phase consisting of tricalcium phosphate and calcium carbonate. Pullout force and stripping load of cancellous screws were determined along with screw pullout force before and after reinforcement with either polymethylmethacrylate (PMMA) or PPF composite. Pullout force was moderately correlated (R2 = 0.59) with apparent density by a power law relationship of the form 0.065p1.37-1.77. Stripping load was strongly correlated (R2 = 0.91) with apparent density by a power law of the form 0.13p1.35-93.8. Mean pullout force before and after reinforcement with PMMA was 382 +/- 100 N (mean +/- standard deviation) and 879 +/- 315 N, respectively. Mean pullout force before and after reinforcement with PPF composite was 571 +/- 294 N and 829 +/- 354 N, respectively. Although the increase in pullout force with cement reinforcement was highly significant in both cases, the magnitude of the increase did not depend on the type of cement. Thus PPF seems to provide reinforcement that is equivalent to that provided by PMMA.

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PubMed1992

Failure of growth hormone to alter the biomechanics of fracture-healing in a rabbit model.

Standardized tibial osteotomies were created and stabilized with external fixation in twenty-seven skeletally mature rabbits. Fourteen animals were treated with a daily injection of human growth hormone (150 micrograms per kilogram of body weight), and thirteen received a daily injection of saline solution. Serial non-destructive biomechanical tests, radiography, and determinations of the levels of serum insulin-like growth-factor I were performed for all of the animals. Destructive strength-testing of the sites of osteotomy was performed at four, six, or eight weeks. Twenty-five of the twenty-seven osteotomies healed uneventfully. There were no significant differences in the serial biomechanical measurements at the sites of the healing osteotomies, in the radiographic measurements, or in the ultimate strength of the sites of the osteotomy between the two groups. The mean level of serum insulin-like growth-factor I increased 33 per cent relative to the preoperative baseline level in the group that received growth hormone and increased 10 per cent in the control group. This difference was not statistically significant. There was no significant correlation between the biomechanical properties at the sites of the osteotomies and the levels of serum insulin-like growth-factor I. Administration of growth hormone had no measurable effect on fracture-healing in this model of normal animals. It remains to be determined whether injection of growth hormone might affect healing when there is a state of deficiency of endogenous growth hormone or when there is a non-union of a fracture.

Analysis of Variance↗

PubMed1991

Biomechanical evaluation of a biodegradable composite as an adjunct to internal fixation of proximal femur fractures.

Internal fixation of comminuted unstable fractures of the severely osteoporotic proximal femur is sometimes supplemented with polymethyl-methacrylate (PMMA). We here report an in vitro biomechanical evaluation of a biodegradable particulate composite that might be used for similar purposes. The composite includes a matrix phase consisting of a hydrolyzable prepolymer [polypropylene fumarate (PPF)] cross-linked with methacrylate monomer, and a particulate phase consisting of tricalcium phosphate and calcium carbonate. We implanted dynamic hip screws in 22 cadaveric proximal femora and measured the yield load for an oblique force applied to the femoral head. The hip screws were then reinforced with either PMMA or the PPF composite and tested again. On the basis of analysis of variance, the average increases in yield load for PMMA and PPF reinforcement of 1,750 and 1,130 N were statistically significant (p less than 0.00005), suggesting that both materials enhance congruence between implant and bone and thereby increase the projected load-bearing area of the implant. The increase in yield force with PMMA was slightly higher than the increase with PPF (p less than 0.05), but both values after reinforcement were close (3,790 +/- 561 N for PMMA vs. 3,240 +/- 669 N for PPF). If we can demonstrate that appropriate rates of degradation, bony ingrowth, and static and fatigue properties can be achieved in vivo with this system, our data suggest that this PPF composite may have potential as an adjunct to the internal fixation of unstable fractures of the osteoporotic hip.

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PubMed1991

Role of interfragmentary strain in fracture healing: ovine model of a healing osteotomy.

It has been hypothesized that the histological pattern of fracture healing is controlled at least in part by the local mechanical strains in the interfragmentary region. To test this "interfragmentary strain hypothesis," we applied cyclic bending deformations to tibial osteotomies in 11 sheep. An instrumented flexible plate spanning a 1-mm osteotomy gap was deformed to create a gradient of tissue elongation from 10% under the plate to 100% at the opposite cortex. The cyclic deformations were applied three times per minute, 24 h per day, for 1-5 weeks. However, as a result of tissue differentiation, the bone-plate complex increased in stiffness with healing time, resulting in a marked reduction of the gap deformation at approximately 4 weeks. Fracture healing was evaluated using vascular injection of India ink and conventional histology. A nonlinear three-dimensional finite element model of the interfragmentary tissue at the initial stage of healing was used to predict the complex tissue strains. The ingrowth of vascularized soft tissue into the interfragmentary gap, as well as the subsequent differentiation of this tissue, occurred earlier and to a greater degree in regions of lower strain. In contrast, the proliferation of callus tissue was greatest at the periosteal and endosteal surfaces of the cortex opposite the plate. Direct comparison of the finite element predictions with the histology demonstrated that the spatial distribution of bone resorption at the fracture fragment ends directly corresponded to the locations of elevated tissue strain and stress. However, there was no consistent numerical relationship between the magnitude of these local peak strains and the corresponding volume of cortical bone resorption over the bone cross section.

Animals↗

PubMed1991

Correlations between photon absorption properties and failure load of the distal radius in vitro.

The bone mineral content (BMC) and cross-sectional properties of cadaveric radii were assessed by single photon absorptiometry (SPA). A new multiple-angle scanning technique was used in conjunction with SPA to measure the area and moments of inertia of the radial cross section in intact forearms. The radii of the same forearms were then broken in a failure test to simulate a fall on the outstretched arm. Colles' fracture was produced in 16 of 18 radii tested. The BMC divided by the bone width, which is called bone mineral density (BMD) in clinical applications, did not correlate with the load at failure in cadaveric forearms. The BMC alone did correlate significantly with failure load (r2 = 0.62), and the cross-sectional properties gave the best correlation with failure load in a sequential multiple regression (r2 = 0.80). We conclude that if SPA is to be used in clinical studies to predict risk of radial fracture or of fractures at remote skeletal sites, then BMC should be used rather than BMD. An even better indicator of radial bone strength than BMC would be a biomechanical parameter derived from the cross-sectional area and moments of inertia, which can be obtained from multiple-angle SPA.

Absorptiometry, Photon↗

PubMed1991

Physical and mechanical properties of calf lumbosacral trabecular bone.

The physical and mechanical properties of calf lumbar and sacral trabecular bone were determined and compared with those of human trabecular bone. The mean tissue density (1.66 +/- 0.12 g cm-3), equivalent mineral density (169 +/- 36 mg cm-3), apparent density (453 +/- 89 mg cm-3), ash density (194 +/- 59 mg cm-3), ash content (0.6 +/- 0.05%), compressive strength (7.1 +/- 3.0 MPa) and compressive modulus (173 +/- 97 MPa) of calf trabecular bone are similar to those of young human. There were moderate, positive linear correlations between apparent density and equivalent mineral density, ash density, and compressive strength; and between compressive strength and equivalent mineral density (R2 ranging from 0.35 to 0.48, p less than 0.001). Apparent density, ash density, and equivalent mineral density did not differ significantly in different regions. In contrast to humans, the compressive strength increased from posterior, near the facet, to the anterior vertebral body. These comparisons of physical and mechanical properties, as well as anatomical comparisons by others, indicate that the calf spine is a good model of the young non-osteoporotic human spine and thus useful for the testing of spinal instrumentation.

Animals↗

PubMed1991

Mechanical properties of metaphyseal bone in the proximal femur.

We used a three-point bending test to investigate the structural behavior of 123 rectangular flat plate specimens harvested from the metaphyseal shell of the cervical and intertrochanteric regions of five fresh/frozen human proximal femora. For comparison purposes, 36 specimens of similar geometry were also fabricated from bone of the femoral diaphysis. All specimens were oriented in either the local longitudinal or transverse directions. The mean longitudinal elastic modulus was 9650 +/- 2410 (SD) MPa and demonstrated a 24% decrease from that measured for the diaphysis (12500 +/- 2140 MPa) using the same testing technique. However, the transverse elastic moduli did not differ significantly between the proximal (5470 +/- 1720 MPa) and diaphyseal (5990 +/- 1520 MPa) specimens. The globally averaged values for the ultimate tensile strengths of the metaphyseal shell were 101 +/- 26 MPa in the longitudinal and 50 +/- 12 MPa in the transverse directions. These compared with diaphyseal values of 128 +/- 16 MPa and 47 +/- 12 MPa, respectively. While these differences were largely due to the reduced density of the proximal specimens, a slight decrease in transverse anisotropy for the proximal specimens was also noted by comparing the ratio of longitudinal to transverse moduli (1.76) and tensile strength (2.02) to the diaphyseal values (2.09 and 2.71, respectively). Use of these data should lead to improved performance of analytical models for the proximal femur, and thus help focus increased attention on the structural contribution of trabecular bone to the strength and rigidity of the proximal femur.

Acrylic Resins↗

PubMed1991

Variations of stiffness and strength along the human cervical spine.

The load-displacement response and strength of the mid (C2-C5) and lower (C5-T1) cervical regions were determined for combinations of sagittal loads, in vitro. In unpaired t-test comparisons, the mid cervical region was significantly stiffer in compression and extension than the lower region. In tests to failure, failure in six out of seven mid cervical specimens resulted from flexion alone, while combined compression-flexion was required to fail five of the eight lower cervical specimens. Post-test dissections revealed no regional differences in the pattern of failure. In addition to sagittal tests, the load-displacement responses of three-vertebrae cervical specimens were measured with the upper body axially rotated with respect to the lower body. The effect of this pre-torsion was to diminish the zone of low slope near zero load for axial, shear, and flexion motion. Three of the four axially rotated specimens failed in flexion without added compression. These controlled load-displacement measurements of cervical spine specimens describe for the first time the continuous flexion-compression response up to failure, and suggest that consideration of the biomechanics of three apparently distinct mobile regions of the cervical spine (C1-C2, C2-C5, C5-T1) may facilitate the interpretation of hazardous conditions and the diagnosis of injury. These data also provide basic information for the in vitro investigation of passive cervical spine protection such as helmets and head-rests, suggesting that the head should be kept in a non-rotated position to reduce risk of injury.

Biomechanical Phenomena↗

PubMed1991

Compressive behavior of human bone-cement composites.

Current surgical practice in the implantation of cemented total joint arthroplasties generally creates a zone of variable thickness in which polymethylmethacrylate (PMMA) is intermixed with trabecular bone. The authors' objectives in these experiments were to characterize the compressive mechanical properties of this bone-cement composite material. They found that the mechanical properties of bone-cement composite specimens, fabricated under in vitro conditions that would promote nearly complete cement filling, are closer to the properties of trabecular bone than to those of cement. For both low-viscosity cement (LVC) and PMMA specimens, with the cement introduced by either hand-packing or pressurized injection at periods of 2 and 7 minutes, the compressive strengths ranged from 29 MPa to 50 MPa and the compressive moduli from 539 MPa to 1,210 MPa. Cement volume fractions achieved using different filling methods ranged from 76% to 87%. In contrast to previous studies of bone-cement composites using high-density bovine bone, neither mechanical properties nor filling parameters correlated significantly with bone porosity measured prior to filling. The authors expect that the mechanical properties of bone-cement regions created at surgery under less than these ideal in vitro filling conditions will only approach their values as an upper limit. Thus, bone-cement composites created in situ at surgery will also exhibit mechanical properties well below previously assumed values.

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PubMed1991

Local demineralization as a model for bone strength reductions in lytic transcortical metastatic lesions.

The structural consequences of bone density changes associated with lytic metastatic lesions were investigated using an experimental model of regular, lytic metastatic lesions in bone. Circular holes were drilled in the mid-diaphyseal cortex of paired adult canine femora. The region around the defect was demineralized in one bone of each pair with 0.8 N HCl. Specimens were tested to failure in four-point bending. Defect size was determined from conventional planar radiographs as the maximum apparent defect diameter divided by the periosteal diameter. Demineralization resulted in irregular defect geometries, which increased the maximum defect dimension 33% to 57% with respect to the original drill hole diameter. Demineralization resulted in additional strength reductions beyond those expected from the original drill hole alone. Despite the irregular demineralization patterns observed, strength reductions were in close agreement with those predicted from data for regular, nondemineralized holes (r2 = 0.93). The results demonstrate that irregular diaphyseal defect borders may not require more complex fracture risk predictors than can be determined from analytic and experimental studies of regular defect geometries. Our results also demonstrate that errors of over 100% can occur when measuring diaphyseal defect size from radiographs that are not optimally aligned with respect to the defect.

Animals↗

PubMed1991

Three-dimensional load displacement properties of posterior lumbar fixation.

Pedicular fixation devices for the posterior treatment of segmental spinal instability are thought to offer enhanced stabilization compared with sublaminar wire systems, while avoiding the immobilization of multiple normal motion segments. We compared the performance of three dissimilar stabilization systems: the Hartshill rectangle, the Acromed/Steffee interpedicular screw and plate, and the Synthes/Dick fixateur interne. Human cadaveric lumbosacral specimens were first tested intact, then after a laminectomy and a facetectomy at the L3/L4 level, and finally after the fixation devices were sequentially attached. Constructs spanning two to four vertebral levels were compared for stabilization of the resected lumbar spine segments. When tested in compression, the Acromed/Steffee system with pedicular screws at L2-L5 allowed significantly less intersegmental distraction than the Synthes/Dick construct with screws at L2 and L5 only, and less than the intact and the destabilized uninstrumented spine. When sagittally rotated, the Acromed/Steffee construct with screws at L2-L5, or at L2 and L5, allowed significantly less distraction than the intact or destabilized segments, and the construct with screws at L2 through L5 allowed less distraction than the Synthes/Dick constructs with screws at L3/L4 or L2/L5. With the exception of the Acromed/Steffee system with screws at four levels, there were no significant differences in distraction allowed between the Synthes/Dick and Acromed/Steffee constructs, or between the multisegment and single segment constructs. There were no significant differences in stiffness across levels L3/L4 with the various implants. Results indicate that the use of posterior spine constructs significantly augment the stability of posterior segmental defects. Pedicular fixation immediately cephalad and caudad to the defect provided stable fixation in this application.

Bone Plates↗

PubMed1991

Importance of bone mineral density in instrumented spine fusions.

The effect of equivalent mineral density on pedicular screw fixation strength was investigated. The equivalent mineral density of human vertebral bodies was correlated highly with the pullout force of Kluger screws (r2 = 0.61, P less than 0.02). A moderate to high correlation existed between density and vertical force (r2 = 0.42 for Kluger screws, r2 = 0.55 for Steffee screws, P less than 0.02). In calf vertebral bodies of higher density (146 +/- 14 mg/cc), the forces were significantly higher than in the human vertebral bodies (P less than 0.05). Human lumbosacral spines were instrumented with three different fixators: Steffee plates, AO fixateur interne, and Kluger fixateur interne. Of five specimens with a mean density of 88 +/- 11 mg/cc, one screw loosened. More than one screw loosened in six specimens with a mean density of 63 +/- 12 mg/cc, and no screw loosened in four specimens with a mean density of 114 +/- 38 mg/cc. Measurement of equivalent mineral density correlates with the fixation strength of the intrapedicular screws in vitro and should be considered in patients with signs of osteopenia before using pedicular screws for spinal fusions. It is also concluded that calf spines are a good model for testing implants because they tend to focus failure processes in the implant rather than in the implant-bone interface.

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