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Analysis of the torque applied to bone screws by trauma surgeons. Comparisons based on years of experience and material of implant construction.

Stability of an internal fixation construct is dependent on the torque placed on the screws holding the plate, the number of screws in the construct, and the number of cortices purchased by each screw. This study addresses the ability of surgeons to apply uniform torque and the variability between stainless steel and titanium. A total of 630 measurements were made by trained orthopedists using a device to measure the torque applied to 3.5 mm screws when tightening them to a plate. Variations were found to be significant depending on the number of years the orthopedist was in practice and the type of construct material used. The average torque applied to a stainless steel construct is 5.82 in-lb, while the torque applied to titanium is 5.41 in-lb (P < 0.01). The longer an orthopedist is in practice, the more torque will be applied to the screw/plate construct.

Biomechanical Phenomena↗

Torques developed by different types of shoes on various playing surfaces.

The purpose of this investigation was to determine the effects of shoe type, playing surface, weight supported and stance position upon the torques developed at the shoe-turf interface. The study was predicated upon the assumption that many knee injuries are torque-related and due to foot fixation, either by rigid cleating or by excessive traction between the shoe and playing surface. A laboratory apparatus was designed to measure the torque developed by various shoe-surface combinations. Under investigation were 11 shoe types, three artificial surfaces and natural grass, two player weights, and two player foot-stance positions. Torque data were gathered using impact loading, with an impact energy that is probably often experienced under competitive playing conditions. Resulting data indexed the shoes according to the mean torques developed on each of the playing surfaces, and comparisons of torque data with field studies by other researchers suggested which shoe-surface combinations might be the most potentially hazardous.

Ankle Injuries↗

Comparison between uniaxial pull-out tests and torque measurement of 2.0-mm self-tapping screws.

This study investigates the retentive capacity of 2.0-mm self-tapping screws in porcine rib utilizing axial pull-out tests as well as torque measurements of insertion and stripping. These techniques have been performed independently; this analysis assesses the association between pull-out and torque values. The Goodman-Kruskel correlation coefficient between pull-out and insertional torque is 0.13, while the correlation between pull-out and stripping torque is 0.21. Partial correlation indexes control the thickness of bone, a confounding factor. Nonparametric analysis of covariance showed no significant difference between insertion of screws and pull-out of the screws, but stripping versus pull-out test was significant. Given these findings, it appears that insertional torque may be used as an alternative technique for screw retention analysis. Because insertional torque tests can be conducted in the operating room, results of clinical studies can be compared to laboratory analyses.

Analysis of Variance↗

Effects of isokinetic muscle activity on pressure in the supraspinatus muscle and shoulder torque.

Work-related shoulder pain is an increasing problem. Work in overhead positions, which causes high pressure in the supraspinatus muscle, has been shown to increase the shoulder load. It is not known how different types of muscle activity in the shoulder affect pressure in the muscle. The aim of this study was to investigate the difference between contraction modes. This has not been done before for shoulder muscles. The results are relevant from several aspects, both clinical and experimental. Pressure in the supraspinatus muscle and torque generation in the shoulder during isokinetic concentric and eccentric activity were measured in nine healthy human subjects. Torque and arm position were measured continuously with a computerized ergonometer. The contraction velocity was 60 degrees per second, and the range of movement was 0-120 degrees of abduction. Electromyographic measurements were recorded with a surface electrode above the supraspinatus muscle belly. Intramuscular pressure was recorded with a microcapillary infusion technique. Peak intramuscular pressure did not differ significantly between the two modes of contraction, but the peak was reached at 115 degrees (SD = 15 degrees) of abduction during concentric activity and at 6 degrees (SD = 7 degrees) of abduction during eccentric activity. The ratio between intramuscular pressure and torque was 3.0 mm Hg/Nm (0.40 kPa/Nm) during concentric activity and 2.3 mm Hg/Nm (0.31 kPa/Nm) during eccentric activity. The peak torque occurred at 44 degrees of abduction during concentric muscle activity and at 74 degrees of abduction during eccentric activity. Intramuscular pressure was higher during isometric contraction than during eccentric and concentric activity, and the torque was in between the two latter contraction modes. We conclude that the supraspinatus muscle is heavily loaded not only in high arm positions during concentric contraction but also during eccentric contraction in arm positions of 0-30 degrees of abduction.

Adult↗

Forces and torques during fracture reduction: Intraoperative measurements in the femur.

Reduction is a crucial step in fracture treatment. We determined intraoperative peak forces and torques during fracture reduction in seven patients with eight fractures of the femoral shaft. All fractures were temporarily stabilized by external fixation. Force and torque measurements were performed during the subsequent intramedullary nailing procedure. A three-dimensional load cell was attached to the distal femur fragment using two Schanz screws. All forces and torques were registered on-line during the reduction process. The maximum resulting force was 411 N, the maximum resulting torque 74 N x m. The highest force was observed along the shaft axis with 396 N for distraction. The maximum torque value was measured around the frontal axis, being 74 N x m for antecurvature. These results may assist the development of new reduction techniques and devices.

Adult↗

Within-train neuromuscular propagation varies with torque in paralyzed human muscle.

Electromyographic (EMG) recordings may serve an important role in predicting torque during repetitive activation of paralyzed muscle. We compared the initial M-wave to the subsequent M-waves of the same train under fatigued and recovered conditions in the paralyzed human soleus muscle. Sixteen individuals with chronic (n = 13) or acute paralysis (n = 3) had the tibial nerve activated before and after a repetitive supramaximal stimulation protocol. The mean within-train M-wave amplitude and median frequency increased approximately 20%, whereas the duration decreased approximately 15% compared with the initial M-wave of each train. During fatigue, there was a linear decrease in the difference between the initial M-wave amplitude and subsequent train ( approximately 20% to 8%). Following fatigue, this difference recovered to approximately 12%. The difference between the M-wave train average and the initial M-wave for amplitude, duration, and median frequency closely followed torque (Pearson correlations = 0.99, 0.94, and 0.98, respectively) during fatigue. We conclude that the difference between the later-occurring M-waves (average of the train) and initial M-wave is large when muscle torque is high and less when torque is low and, therefore, predicts torque during activation of paralyzed muscle. This difference in the within-train M-wave amplitude, duration, and median frequency may reflect a mechanical change, such as muscle shortening and increased muscle cross-sectional area during isometric contractions. Electromyographic feedback may assist in the optimization of neuromuscular electrical stimulation of paralyzed muscle.

Action Potentials↗

Modifiability of abnormal isometric elbow and shoulder joint torque coupling after stroke.

Unlike individuals with mild stroke, individuals with severe stroke are constrained to stereotypical movement patterns attributed to abnormal coupling of shoulder abductors with elbow flexors, and shoulder adductors with elbow extensors. Whether abnormal muscle coactivation and associated joint torque patterns can be changed in this population is important to determine given that it bears on the development of effective rehabilitation interventions. Eight subjects participated in a protocol that was designed to reduce abnormal elbow/shoulder joint torque coupling by training them to generate combinations of isometric elbow and shoulder joint torques away from the constraining patterns. After training, subjects demonstrated a significant reduction in abnormal torque coupling and a subsequent significant increase in ability to generate torque patterns away from the abnormal pattern. We suggest the rapid time-course of these changes reflects a residual capacity of the central nervous system to adapt to a novel behavioral training environment.

Adult↗

Impact of varying pulse frequency and duration on muscle torque production and fatigue.

Neuromuscular electrical stimulation (NMES) involves the use of electrical current to facilitate contraction of skeletal muscle. However, little is known concerning the effects of varying stimulation parameters on muscle function in humans. The purpose of this study was to determine the extent to which varying pulse duration and frequency altered torque production and fatigability of human skeletal muscle in vivo. Ten subjects underwent NMES-elicited contractions of varying pulse frequencies and durations as well as fatigue tests using stimulation trains of equal total charge, yet differing parametric settings at a constant voltage. Total charge was a strong predictor of torque production, and pulse trains with equal total charge elicited identical torque output. Despite similar torque output, higher- frequency trains caused greater fatigue. These data demonstrate the ability to predictably control torque output by simultaneously controlling pulse frequency and duration and suggest the need to minimize stimulation frequency to control fatigue.

Action Potentials↗

Study of the extent of torque, protrusion and intrusion of the incisors in the context of Class II, division 2 treatment in adults.

AIM: The aim of this study was to analyze the relative contribution of torque and protrusion to the change in incisor inclination in the treatment of Class II, Division 2 malocclusion with fixed appliances. Furthermore, the extent of incisor intrusion was to be evaluated. The second part of the study was aimed at documenting the stability of the therapeutic outcome in terms of inclination and intrusion within the framework of a follow-up examination. PATIENTS AND METHOD: The study sample comprised 25 adult patients, and the follow-up sample eleven patients. The intrusion and change in inclination of the incisors as well as their stability were analyzed by evaluating and superimposing lateral cephalograms taken before and after treatment as well as after retention. RESULTS: Although the mean value of inclination at the end of the therapy was in accordance with the standard value (102 degrees), there was a marked interindividual variation. In the maxilla, the mean torque component was 58%, and the mean protrusion component 42%. In the mandible, the torque: protrusion ratio was 37%:63%. The mean intrusion was 1 mm in both dental arches. The follow-up examination showed that the intrusion was relatively stable. In cases where the change in inclination relapsed, the ratio of protrusion to torque was almost equal to that previously used to induce the change during the course of treatment. CONCLUSION: It is concluded that therapy with torque movement and intrusion offers a more stable result in adults than protrusion movement alone.

Adolescent↗

Torque deformation characteristics of plastic brackets: a comparative study.

AIM: The purpose of this study was to compare the torque deformation characteristics of seven commercially available plastic brackets, both amongst each other and with stainless steel brackets. MATERIAL AND METHODS: Ten brackets each of (1) pure polycarbonate, (2) ceramic reinforced polycarbonate, (3) fiberglass reinforced polycarbonate, (4) ceramic reinforced polycarbonate with metal slot, (5) fiberglass reinforced polycarbonate with metal slot, (6) polyurethane, and (7) polyurethane with metal slot were exposed to torsion in a torquemeter, following an aging process according to ISO 10477. Ten stainless steel brackets served as a control group. Torsion was applied continuously using a material testing machine (Zwick Z2.5, Zwick Materialprüfung, Ulm, Germany). RESULTS: The results showed within the group of plastic brackets that metal slot reinforced brackets were subject to the lowest degree of deformation, followed by the brackets made of pure polyurethane, pure polycarbonate and fiberglass reinforced polycarbonate. The ceramic reinforced polycarbonate brackets showed the highest deformation under torque stress. The plastic deformation of the ceramic reinforced, fiberglass reinforced and pure polycarbonate brackets started even in the recommended torque range of 10-20 Nmm. The additional ceramic and fiberglass in the plastic brackets investigated in this study did not improve the torque stability of the polycarbonate brackets. The pure polyurethane brackets showed no significant difference from the pure polycarbonate brackets at the moment of 15 Nmm which is the optimal torque for a maxillary incisor. CONCLUSION: A comparison with the stainless steel brackets illustrated that plastic brackets are suited for clinical application only if they have a metal slot.

Biomechanical Phenomena↗

Neuromuscular-skeletal constraints on the acquisition of skill in a discrete torque production task.

The organisation of the human neuromuscular-skeletal system allows an extremely wide variety of actions to be performed, often with great dexterity. Adaptations associated with skill acquisition occur at all levels of the neuromuscular-skeletal system although all neural adaptations are inevitably constrained by the organisation of the actuating apparatus (muscles and bones). We quantified the extent to which skill acquisition in an isometric task set is influenced by the mechanical properties of the muscles used to produce the required actions. Initial performance was greatly dependent upon the specific combination of torques required in each variant of the experimental task. Five consecutive days of practice improved the performance to a similar degree across eight actions despite differences in the torques required about the elbow and forearm. The proportional improvement in performance was also similar when the actions were performed at either 20 or 40% of participants' maximum voluntary torque capacity. The skill acquired during practice was successfully extrapolated to variants of the task requiring more torque than that required during practice. We conclude that while the extent to which skill can be acquired in isometric actions is independent of the specific combination of joint torques required for target acquisition, the nature of the kinetic adaptations leading to the performance improvement in isometric actions is influenced by the neural and mechanical properties of the actuating muscles.

Adaptation, Physiological↗

Greater trunk muscle torque reduces postmenopausal bone loss at the spine independently of age, body size, and vitamin D receptor genotype in Japanese women.

Bone mineral density (BMD) is affected by muscle strength. Recently, vitamin D receptor (VDR) genotype was reported to affect muscle strength as well as BMD in Caucasian women. The aim of this study was to evaluate independent effects of muscle strength of the trunk on BMD at the spine and its change over time in Japanese women. We followed 119 healthy postmenopausal women for 4 years and determined the change in BMD at the spine by dual energy X-ray absorptiometry. Isometric peak torque and isokinetic concentric and eccentric peak torque of the trunk flexors and extensors were measured. The VDR genotype was determined by the PCR-RFLP method based on Apa I and Taq I endonuclease digestions defining the absence/existence of the restriction sites as A/a and T/t, respectively. The subjects were 60.1 +/- 6.6 years old, had 0.808 +/- 0.159 g/cm2 of BMD at baseline. The mean annual change in BMD (delta BMD) was -5.6 +/- 10.4 mg/cm2 during the follow-up period. The VDR genotype, defined by Taq I enzyme, significantly related to BMD at baseline and delta BMD showing that the subjects with genotype TT had the lowest BMD at baseline and lost bone most rapidly. However, its effect on muscle strength was not significant. All the trunk muscle strength indices showed significant positive effects on delta BMD, that is, the effects in increasing the gain and reducing the loss of BMD, after controlling for the effects of age, body size and the VDR genotype. The eccentric trunk extensor torque had a significant positive effect on delta BMD in a dose-dependent manner. The effect of this torque was the greatest among all the muscle indices. The net effect of the trunk extensor torque on delta BMD was greater than that of the VDR genotype. The trunk muscle strength was suggested to affect BMD change independently of age, body size, and the VDR genotype. Exercise programs to increase the strength of the trunk muscles would be beneficial for the prevention of osteoporosis regardless of the VDR genotypes.

Absorptiometry, Photon↗

Torque loss induced by repetitive maximal eccentric contractions is marginally influenced by work-to-rest ratio.

The influence of different work-to-rest (W:R) ratios during fatigue induced by maximal eccentric contractions is unknown. The present study sought to expand the understanding of the task-dependent nature of eccentric contractions, and the associated fatigue, during exercise and acute as well as extended recovery periods. Using a Biodex multi-joint dynamometer, the ankle dorsiflexors of eight men [26 (4) years] were fatigued with 150 maximal eccentric contractions. Set structure was manipulated such that one leg performed 3 sets of 50 repetitions (short rest protocol, SRP), and the other leg performed 15 sets of 10 repetitions (long rest protocol, LRP). A 1-min rest interval separated each set, which resulted in 2 and 14 min of total rest for the SRP and the LRP, respectively. At fatigue, the SRP demonstrated a marginally greater loss of average peak eccentric torque than the LRP ( P<0.05). In the acute period following fatigue, isometric peak torque loss and the degree of low-frequency fatigue (LFF) were not recovered ( P<0.05) and were equivalent for both protocols. Significant impairment of both eccentric and isometric torque was persistent and equal for each protocol at 96 h of recovery ( P<0.05). These findings suggest that the W:R ratio has a modest influence on the fatigue (torque loss) induced by maximal eccentric contractions, but maximal isometric torque during recovery and LFF are insensitive to changes in total rest time.

Adaptation, Physiological↗

Reduced plantarflexor specific torque in the elderly is associated with a lower activation capacity.

Previous studies have reported a decrease in muscle torque per cross-sectional area in old age. This investigation aimed at determining the influence of agonists muscle activation and antagonists co-activation on the specific torque of the plantarflexors (PF) in recreationally active elderly males (EM) and, for comparison, in young men (YM). Twenty-one EM, aged 70-82 years, and 14 YM, aged 19-35 years, performed isometric maximum voluntary contractions (MVC). Activation was assessed by comparing the amplitude of interpolated supramaximal twitch doublets at MVC, with post-tetanic doublet peak torque. Co-activation of the tibialis anterior (TA) was evaluated as the ratio of TA-integrated EMG (IEMG) activity during PF MVC compared to TA IEMG during maximal voluntary dorsiflexion. Triceps surae muscle volume (VOL) was assessed using magnetic resonance imaging (MRI), and PF peak torque was normalised to VOL (PT/VOL) since the later approximates physiological cross-sectional area (CSA) more closely than anatomical CSA. Also, physical activity level, assessed by accelerometry, was significantly lower (21%) in the elderly males. In comparison to the YM group, a greater difference in PT (39%) than VOL (19%) was found in the EM group. PT/VOL and activation capacity were respectively lower by 25% and 21% in EM compared to YM, whereas co-activation was not significantly different. In EM PT/VOL correlated with activation (R(2)=0.31, P<0.01). In conclusion, a reduction in activation capacity may contribute significantly to the decline in specific torque in the plantar flexors of elderly males. The hypothesis is put forward that reduced physical activity is partialy responsible for the reduced activation capacity in the elderly.

Activities of Daily Living↗

The relationship between plasma potassium concentration and muscle torque during recovery following intense exercise.

The present study investigated the relationship between plasma potassium ion concentration ([K+]) and skeletal muscle torque during three different 15-min recovery periods after fatigue induced by four 30-s sprints. Four males and one female completed the multiple sprint exercise on three separate days; recovery was passive, i.e. no cycling exercise (PRec), active cycling at 30% peak oxygen consumption. VO2peak (30% Rec) and active cycling at 60% VO2peak (60% Rec). Plasma [K+] was measured from blood sampled from an antecubital vein of subjects at rest and at 0, 3, 5, 10 and 15 min into each recovery. Isokinetic leg strength was measured at rest and at 1, 6, 11 and 16 min during each recovery. Following the exhaustive sprints, [K+] increased significantly from an average mean (SEM) resting value of 3.81 (0.07) mmol.l-1 to 4.48 (0.19) mmol.l-1 (P < 0.01). In all recovery conditions, plasma [K+] returned to resting levels within 3 min following the fourth sprint. However, in the two active recovery conditions plasma [K+] increased over the remainder of the recovery periods to 4.36 (0.12) mmol.l-1 in the 30% Rec condition and 4.62 (0.12) mmol.l-1 in the 60% Rec condition, the latter being significantly higher than the former (P < 0.01). The maximum torque measured following the sprints decreased significantly, on average, to 61.1 (8.36)% of peak levels (P < 0.01). After 15 min of recovery, maximum torque was highest in the 30% Rec condition at 92.13 (3.06)% of peak levels (P < 0.01), compared to 85.23 (3.64)% and 85.71 (0.82)% for the PRec and 60% Rec conditions, respectively. In contrast to the significant differences in plasma [K+] across all three recovery conditions, muscle torque recovery was significantly different in only the 30% Rec condition. In summary, recovery of peak levels of muscle torque following fatiguing exercise does not appear to follow changes in plasma [K+].

Adult↗

Recovery of the torque-velocity relationship after short exhausting cycling exercise.

The effects of fatigue upon the torque-velocity (T-omega) relationship in cycling were studied in 11 subjects. Fatigue was induced by short exhausting exercise, on a cycle ergometer, consisting of 4 all-out sprints without recovery. The linear (T-omega) relationship was determined during each all-out sprint, before, during and after the exhausting exercise. The kinetics of the T-omega relationship had permitted the study of the recovery of optimal torque, optimal velocity and their corresponding maximal power outputs (Pmax), 30 s or 1 min after the short exhausting exercise. Fatigue induced a parallel shift to the left of the T-omega relationship which was partly reversed by a parallel shift to the right during recovery. After 30 s recovery optimal velocity, optimal torque and Pmax were slightly lower than the corresponding values before the exhausting exercise; after 1-min optimal velocity and optimal torque had recovered 99% and 97% of their initial values. These mechanical data suggested that the causes of exhaustion were processes that allowed fast recovery of both optimal velocity and optimal torque.

Adult↗

The relation between granule size, granule stickiness, and torque in the high-shear granulation process.

PURPOSE: To investigate the background of the observed relationship between measured torque and granule size in high-shear granulation processes. METHODS: Torque was measured during the granulation process; the behavior of individual wet granules during compaction was investigated using micromanipulation. Surface properties of wet granules were manipulated by coating them with talc. RESULTS: The torque-granule size relationship could not be explained by the rise in mass of the individual granules; it occurs rather through an increase in stickiness of the granules when the moisture content is increased. Obviously, the increased stickiness that causes the granules to grow also increases the torque. Increased stickiness was shown to be the result of an increased deformability of the granules at higher moisture contents, in combination with a change in surface properties. The elastic-plastic behavior (ratio of elastic to plastic deformation) was found to change at increasing moisture contents. CONCLUSIONS: Our results imply that changes in the stickiness of the granular material that may be caused by changes in composition shift the torque-size relationship. This may be of particular importance when, for example, granulation results from placebo batches are used to predict the granule size of drug-containing batches.

Particle Size↗

Estimating the contribution of muscles to joint torque based on motor-unit activity.

Because most joints in the human arm are crossed by a number of muscles which exceeds the number of degrees of freedom for those joints, the motor system can use a variety of muscle activation patterns for the same torque in each joint. We have developed a mode to estimate the contribution of individual muscles to the total torque in a joint based on intramuscular EMG recordings. EMG activity recorded with surface electrodes may be contaminated with cross-talk from other muscles. Moreover, it may not be representative for the activation of a muscle when there are several subpopulations of motor units in the muscle. We derive a relation between the recruitment threshold of a motor unit in a subpopulation for force in various directions and the relative contribution by that subpopulation to joint torque. A set of linear equations can then be constructed which relates the contribution of each subpopulation (and therefore of each muscle) to the total joint torque. If the activition of individual subpopulations is modulated differently for forces in various directions, the relative contribution of the individual subpopulations to the total joint torque can be estimated.

Arm↗