Reliability and accuracy of the torque applied to osteosynthesis screws by maxillofacial surgeons and residents

Abstract

Applying the right torque to osteosynthesis screws is important for undisturbed bone healing. This study aimed to compare test–retest and intra-individual reliabilities of the torque applied to 1.5 mm and 2.0 mm osteosynthesis screws by residents and oral and maxillofacial surgeons (OMF-surgeons), to define the reference torque intervals, and to compare reference torque interval compliances. Five experienced OMF-surgeons and 20 residents, 5 of each 4 residency years, were included. Each participant inserted six 1.5 × 4 mm and six 2.0 × 6 mm screws into a preclinical model at two test moments 2 weeks apart (T1 and T2). Participants were blinded for the applied torque. Descriptive statistics, reference intervals, and intra-class correlation coefficients (ICC) were calculated. The OMF-surgeons complied more to the reference intervals (1.5 mm screws: 95% and 2.0 mm screws: 100%) than the residents (82% and 90%, respectively; P = 0.009 and P = 0.007) with the ICCs ranging between 0.85–0.95 and 0.45–0.97, respectively. The residents’ accuracy and reliability were inadequate regarding the 1.5 mm screws but both measures improved at T2 for both screw types compared to T1, indicating a learning effect. Training residents and/or verifying the applied torque by experienced OMF-surgeons remains necessary to achieve high accuracy and reliability, particularly for 1.5 mm screws.

Biomechanical Variability and Usability of a Novel Customizable Fracture Fixation Technique

“…In the AdhFix platform, each screw is inserted carefully 'two-finger tight' to allow the composite to remain under the screw head and function as anchorage to the bone [10]. Screw torque has previously been shown to vary between and within surgeons and may, therefore, contribute to the variability found in this study [24]. Furthermore, the concept of 'two-finger tight' has been shown to be associated with significant variation in torque, bone stripping and lack of reproducibility when screws are placed [25].…”