*At your next Backyard BBQ* Guest: "Why does this dude's deck keep whispering to me? I'm just trying to eat this burger." Spirits: "HELP US! THIEF! HELP US KILL THE THIEF!" Guest: *puts on Bose QuietComfort Ultra Headphones* "That's better." *Seal's "Waiting For You" plays in the background and fades out*
The reason it cost $423 is the same reason my surgeon buddy got a complaint from a patient that the hernia mesh he selected during her surgery was causing issues with her insurance because it’s cost $10,000. He was like “oh, no that’s a mistake”. It wasn’t. When he pressed the manufacturer he was told it was the “industry standard markup”. What was that industry standard markup, you may ask? 400%. That’s right, a whopping 80% of the cost was markup. Her insurance was forced to pay. I’m so over this nonsense.
Thats the main part people dont know. "It's no different than a home depot screw!" But the expensive screw has a papertrail, ceritifications, and testing behind it. But a lot of people would happily take the home depot screw when they see the pricetags 😅
@@RunsWithKniefs No. Dental implants (not made in the USA) cost 100 bucks. There is the same screw that is screwed into the jaw, this is very responsible since repairing the jaw bones is much more difficult and dangerous for the patient. If it doesn’t take root and breaks (why would titanium suddenly break), then you can get pus, pus in the jaw is very bad. The brain is nearby...
Holy crap man. This is somehow all at the same time legitimately good comedy, wildly informative (that bit about threading, shear, and clamp was outstanding), and a bit of social commentary. You are very good at this and I wish you success.
I used to program and setup bone screws on citizen, tornos and star turning centers. Lots of multi axis constant contour bone plates on dmg dmu’s too. Was fun but I cant say I miss the days of medical instruments and implants.
@@Eluderatnight yes sir it is. Pushed me back into being a field repair technician. Kinda funny i did military, aerospace years ago. I dont even miss that lol
It's cannulated (can-you-LATE-ed), nothing new under the Sun for orthopedic surgery. In my tenure as a Surgical Nurse specializing in neuro and orthopedic procedures, we've been inserting rods and screws over a guide wire or pin for 40+ years. You'd really appreciate the dual-pitch screws we use, the threads are on either end of a screw and when screwed across a fracture line, pull the two pieces of bone tightly together. Used in places where a screw head would interfere with joint motion, like the wrist.
I've seen dual pitch screws before to do as you described. One example would be to pull sub-floor tightly together with floor joists to prevent the classic floor creak sound that many are familiar with.
@DeereX748 - I understand that the guide-wire is supposed to avoid the screw itself from slipping while being inserted, but _how do you insert the guide-wire itself in the first place?_ (It seems that there would have to be a hole to insert it, which implies that the surgeon is back to having to drill a hole during which the drill itself could still slip.)
@@im.empimp The guide wire is somewhat flexible and has a trocar type point. It's inserted with a chuck in a drill under fluoroscopy guidance. It can be pulled out and repositioned as necessary, leaves a very small hole if it isn't in the right place to begin with so doesn't affect the final result. Once the guide wire is positioned as desired, the cannulated screw is driven in over the guide wire and then the guide wire gets removed.
It’s so expensive because they attached the word "surgical" to it. It’s sterile, non porous, tested in medical trials, and has been approved by the government for long term use inside the body. (The last two probably sent them back a pretty penny.)
I make screws very similar to that at work. So, the cost for titanium is partly the machining, but a large part is also the traceability requirements. There has to be chain of custody paperwork every step of the way from where it was smelted to the finished screw's serial number, along with documentation of inspections done at each step, like ultrasonic and XRF testing, dimensional inspections of the screw, cleaning, passivation, and sterilization after it's packaged. My standards might be a little skewed, but 6-4 titanium isn't actually that bad to machine, definitely less of a hassle than 300-series Stainless or cobalt-chrome. You absolutely need to run it with flood coolant and have some kind of fire suppression ready, but if you've got that and have the right inserts it behaves itself pretty well. As for the threads, most of those are custom threadforms, not any kind of off-the-shelf thing. Some of them need to be cut with a thread whirler, others can be done with custom inserts in single-point threading tools, and many of them are multiple-start threads. Some of the larger types that get used in spinal surgery will have a 2-start thread for the first inch or so and then switch to a 4-start near the end.
I was working on a roll up door on the back of a semi trailer onsite, the ladder kicked out, and about 10 feet later, straight down and I'm left with a lot of titanium now. That was my Valentine's Day present in 2019, not quite what i had in mind that day I'll tell ya that much. Lol
@@qwerty112311 They don't buy them retail. Did you think Lowe's or Home Depot sells them? You are crazy. They are custom made. Don't laugh too hard. You'll choke on your Bud Light.
The screws come in two different threads depending if they are going into cancelous or cortical bone. Cortical screws have a deep, coarse thread like a chipboard screw, cancellous screws are more like machine screws, and a tap is often slid over the kwire first to cut threads in the bone, before the screw is inserted. If you ask about the cost of the splined screws they use on femoral heads, make sure you’re sitting down. It will have a figure in front of the 4 of yours. - the screw portion goes into the ball end of the femur that is in your pelvis, with the splined shaft in an oversized hole through the neck of the femur. An L shaped plate slides over the shaft and is secured to the screw with a compression screw up the middle. (Like a belt pulley on the end of a crankshaft.) the plate is positioned so it points down the leg and is secured with two or three screws like the one you have here to hold everything in place. The shape of the underside of the screw head fits into an oval machined groove on the plate. The surgeon uses a drill guide to put the screw in the middle of the slot, or to offset it to one end or the other. Placed centrally it provides a clamping force, holding the plate to the bone. When the offset guide is used, due to the shape of the slot and the screw head it can be used to pull/push the plate a millimetre or two to close or open the fracture.
That's backwards. Cancellous screws have the coarse, deep threads. Cancellous bone is light and porous, and needs deep widely spaced (relative) threads to gain purchase. Cortical bone is dense and hard, more like wood and the threads for cortical screws are more finely pitched and smaller. Generally, cortical screw holes are drilled and then pre-threaded (tapped) before inserting a screw, otherwise the screw has a chance of splitting the bone around the hole. Cancellous screws don't need the hole threaded prior to inserting the screw, as the cancellous bone will compress slightly as the screw moves forward. The hip plate you mention in some fashion or another has ben in use for over 40 years, we were using them when I first went to the O.R in 1984. What you mention regarding the slotted holes in the plate is called compression. Putting the screw in a position where the head pushes against the edge of the slot as the screw is tightened causes the fractured bone ends to be forced together. This improves the stability of the fracture and makes healing faster. Think of gluing two rough pieces of wood together (end to end). If you just mate the ends, it's all glue holding the joint together; if you press them together, much of the glue (or the callus, in bone healing) is pushed to the outside edge and the two pieces of wood will be in contact with the remaining glue forced into the fibers. Not a truly accurate comparison, but close. The long screw that fits the angled portion of the plate and enters the femoral neck and into the femoral head (ball) has a large thread at the end made to get a good "bite" in the cancellous bone within the head, This lag screw also has a threaded hole at its other end where a fixation screw goes to hold the lag screw tightly inside its angled hole in the plate, and also provides compression. There are other ways to reduce a hip fracture and pin the head/neck to the shaft, depending on the actual location of the fracture, too many to describe here.
@@DeereX748 And that is precisely why I spent my 35 years in theatre on the clean side of the blood brain barrier! 😁 It's been a while since I had to scrub for a case as the hospital I worked at for the last 25 years was pretty much you do anaesthetics and nothing but, (or scrub or scout, and recovery was a separate department altogether.) There wasn't a great deal of overlap , unlike previous places I worked at where it wasn't unusual to do anaesthetics in the morning and perhaps scrub for a Moores in the afternoon. Before the DHS (dynamic Hip Screw) you mention they used Intertrochanteric nails that looked like long wire nails, and neither I nor my wife can remember the trade name! We never put them in as they had gone out of fashion, but we certainly removed a few! About the early 90's the GK nails came into service providing a better solution.
This was an awesome, funny, and entertaining video! Something to keep in mind about these orthopedic/surgical/ bone screws Is that there is no mass production of them in the same way that regular screws are mass produced. Each screw is individually machined. Each screw must be perfect and completely free of burrs (You don't want a burr breaking off into your body). There is no margin for error.
actually the main reason why they are not cold stamped is a they a from Titainum,which is not really stamp able. Secound thing.IN medical stuff machining, forming parts ist forbiden mostly. For exampe :threats have to be cut,not formed. Cause somehow a formed thread has more risk of having bacteria grow on the surface. Precision wise,you could make those screws like normal ones. Its just the titanium(which could be worked out somehow with a big press and special multistage tooling) and the Medicinal fact with the Sterilnes of the Surface. next thing is. In germany you would pay like sub 1€ for 1000pcs of those screws from steel with a Torx. The thing is.Most companys have a mininmal order amount of like 50K or even 1 Million.Deppending on the screw. Thats the reason they get Turned. But the cost to make them wouldnt be that high. You could take 50 bucks for one and still make a shit ton of money,if there is enough market. Most of the price is just scamming the Healtinsurence.Its the same in germany,just not that stupid like in the staates( insulin couple hundred bucks and so on) Greeting from a tool shop guy in a screw Factory
This might be kinda dark but one of the only things i was looking forward to in the process of cremating a loved one was being able to see/recover the titanium knee and hardware he had put in that cost him like 50 grand... long story short, the cremation business recycled (stole) all of the metals, including gold fillings and a silver coin i left in his pocket.
Well said (40 years in Aerospace Titanium, with some Chemical, bio-medical and other assorted military applications, plus Zirconium, Hafnium and Niobium products thrown in for good measure).
Yep, i immediately thought it was going to be some sort of military aircraft screw. I think the high cost of this is more justified though, you can't open up your ankle every year for an inspection, so I would want to know no expense was spared in the design and QC of my surgical hardware.
I used to work in a machine shop that made bone screws exactly like this plus a bunch of other kinds. The term cannulated (can-you-lay-ted) comes from the work cannula and is just a fancy word that means it's a tube. The heads aren't actually Torx but a special medical-grade kind of torx called "Hexalobe". If you want to see some really cool screws, look up the headless compression screws that use a coarser thread at the tip which gets finer at the end to squeeze two pieces of bone together (usually on very small bones or ones with little muscle tissue over it like on the foot) without leaving an exposed head or needing to countersink the head.
@Jacob-ABCXYZ You definitely want medical implants to be tagged. One obvious reason is if there is a defect in the batch they need to be able to track you down and rectify it. There are probably a few other good reasons too.
The company I work for makes it possible to pull data from the warehouse it-system to the patient care system. If something is wrong with a certain implant or a certain batch then all relevant data can be found readily in the journal - automatically by pulling a list. This was made after failures on some hip implants caused secretaries or doctors to read through patient journals to find the rest. And the info was not alway there.
@@Jacob-ABCXYZ I understand the knee jerk reaction, but it's not like they'd be able to track you by the serialized screw in your leg, if they're reading the serial number you have bigger problems
@@CalamityJay-ez2mq That points to one of my issues with the idea - If they're reading the number, you have bigger problems. Sure. So in the event that 'I'm not needing mine anymore', the serialization is very unlikely to actually benefit me. But I *will* have to pay for the very expensive machining that it's going to take to put it on there in the first place. Because, what? They want to be able to figure out who's leg this is in the unlikely event I happen to be in a plane crash? I don't think I'm really going to care at that point.
Cheers man, never knew there was a proper name for #2 square screws lol. I like how the stay on the drill bit. Also still have two thart I had in my ankle, dont think my ones were hollow though but they were temporary. Ill tell you, the bone will give before the screw LOL.
Honestly, these are pretty much worth it. Its amazing how many tiny details have been thought through and beautifully executed. Imagine what the history of trial and error in surgical screws looks like? Also... Screwvounier? 😃
Those type of screws are usually made on a swiss style CNC machine. Every screw is machined one by one. That's why it's so expensive. Same reason for aerospace parts being expensive. It's the machining process.
Fun fact, if you go to enough machine tool trade shows and go to the swiss type lathe manufacturers, you can usuallt grab a free bone screw. I have a titanium bone screw, and a brass bone nail. The brass one being a show piece, not a functional piece.
I had a holiday job in a screw factory. They were specialized in making screws from any alloy requested by the client. Minimum order quantity was 1 piece. Sometimes orders came in on which clients actually ordered 1 screw made out of specific material. Such a screw was a bit more expensive. It must be, because at this low quantity, the screw was literally hand made from scratch.
the health tech that has this much thought and care put into it is awesome and thanks for the vid ! now modern medicine get to it with IBS , CFS any kind of myalgia . and big one for me until i know its not whats killing me , the wonderful multiple sclerosis
For someone that's had "Several" screws holding body parts on, every example of using house hold screws "Going Wrong" made me cringe. LOVE IT!!! Funny stuff. Keep it up :)
3:37 Canada still uses them, and yes they definitely are better than Phillips, they don’t strip nearly as easily. The head often times snaps before it strips
They sell it for that much, that doesnt make it cost that much or worth that much. its the medical industry so everything costs 100x more then its worth.
My uncle (now passed) worked for an orthopedic manufacturer. My father (also passed) was getting a hip replacement using a manufactured hip by the company my uncle worked for. My uncle had been working there since the beginning of the company in the US. He gave my dad a hip that had a slight flaw in it that the company made to show him what they were going to put in him. I still have it. I'm guessing, if it didn't have that flaw, (I can't find one) it would be a costly item. It's really well made.
Welcome to the Titanium Screw Club! We meat every 5th Whendesnay in months ending in 'i' at the Tabernacle next to the pool hall. Punch and cookies are provided for a nominal fee. For that or tee shirts see Billy Gregor. Proud member since 1997. Two pins in my upper jaw. That asphalt never even saw my face coming!!
I wonder though, i have a shoulder prosthetic and i was told its all a cobalt chrome molybdenum alloy. Is there any differences between that and titanium (besides being different elements ofcourse)
Just a note a metal detector, well detects all metal. Not just if a metal is ferromagnetic. Metal detectors create a magnetic field and when metal passes through that field its changes the field somewhat and they detect that change. All metals will change the field now of course to varying degree. But even gold and titanium can set off a metal detector. Its more about size/quantity and proximity.
Robertson fasteners are still very much around, they seem to be popular in Canada (Fun Fact: BBQ grills from Canada often come with Rrobertson drive fasteners....)
They're called Square drive, these days, now that the patent has expired and anyone can make them. Invented by a Canadian in Canada, IIRC. And they are superior to Phillips head screws. Not sure how they compare to Reed & Prince screws, the other style of cross-point screw. Reed & Prince screws don't have the tapered sections, so should not cam out, but I've not worked with enough of them to know that for sure. Got the difference explained to me in a USAF aircraft maintenance school in 1973-74. I think I've run in to three such screws in my life to this point.
Medical and Aviation both have parts that are significantly more expensive than their material or machining cost. It adds up in the documentation, testing, certifications, provenance, amortized development costs, low production volume and liability insurance.
i work for an orthopedic manufacturing company. we make very similar screws among other things. after these screws come off the machine, they are meticulously tested and measured, then manually deburred by hand under microscope to ensure that there are no burrs or chips or rolled edges along the threads, the hexalobe is glass bead blasted one at a time by hand in a microblaster, then they go through several cycles of ultrasonic cleaning and passivation and then some get anodized a specific color depending on the client wants. so yeah expensive screws.
Is the production cost so high in the us? I mean i get all the steps and extra steps,you wouldnt find on a normal screw thats turned. But still 400Bucks....
I saw an surgeon about my inured back and I was looking at needing titanium pieces to replace the discs for a spinal fusion. They were about 10mm (3/8") thick and 20 (3/4") to 25mm (1") in diameter and in 2008 they cost AUD$8,000 *EACH* and I needed 6 of the little buggers.
my mate showed me a bag of what USED to be in his back... looked sort of like an ikea parts sack... but worse. has a video too. i declined to watch... the titanium rods, where they simply use BOLTCUTTERS to trim them down to length, then sew you back up, sharp edges and all? nah, just a description will suffice, thanks!
i know the feeling. our 3-months young cat Cherrykern got her thighbone broken some mysterious way, right at the end. as we didn't intend watching her being crippled from the beginning of her life, we needed to have it fixed. the vet did it not with such a fancy screw, but a nice piece of hand formed titanium until recovered. unlike us, financially... also never show your keys on the internet.
I have two dental implants.. it's a 6 month procedure. Had it done over 10yrs ago. Cost 3k each. They are more now, but it was the whole procedure, crowns and multi-visits. I was awake and numbed up as he was drilling in my top bone (front of my mouth).. I thought to myself, "what did I agree to, this is crazy?" After they drill and screw in the titanium implant piece (the fixture) they wait months for the bone to grow around it, then after it's confirmed they install a titanium abutment with a crown glued to it. So 3 pieces total, 2 of them titanium. Overall it was interesting and no major issues, unsure how expensive the parts were, but most of the cost is labour, about 2/3. The crowns were likely more expensive than the metal parts too. I have a small x-ray as a keepsake, and my original teeth roots that had failed root canals (only due to trauma). My injury is another story.. but I'm thankful its repaired.
The most unsettling comment I've heard from a surgical nurse was her comment: "Boy, your drill bits are much sharper than ours." (They were low grade twist drills.) I just pray that surgical drills are designed for control, not the speed of the cut.
Tell your surgeon that next time they get surgery!!!! That’s ridiculous. Any bacteria on that could start a bone infection. Give it a google “why are surgical instruments individually packaged.” There may be some new innovations to replace the already sterilized individual bagged components like screws, but the sterilization of the components is a significant reason for their high cost. Think about the coolant and lubricants used when manufacturing screws. That all needs to be removed and then the screw can get sterilized.
@@jasonconstant455 You're probably right, but I'll continue to play the smartass for the sheer fun of it. Removing the surface contaminants is called cleaning and removing the microbes is called sterilizing. Burning accomplishes both in one step. Just blow off the ash and drop it in a baggie!
Same problem in the hardware for military aircraft and especially gas turbine hardware. Some seriously expensive alloys, heat treatments and coatings. Then they get certified and recorded by the population of a small country!
Fun fact: depending on the manufacturer the torx has a special shape that keeps it from dropping of the bit. Fun fact n2: the walls of my garage toilet are held together by some of these screws
I've got 6 of these screws, along with scaffolding, for L5-S1 and L4-L5. Been holding me up since May 15th 2008. Cheers, it's nice to get some perspective and a reminder of what good fortune modern medicine can bring despite our stupidity.
I remember laser engraving the serial numbers on similar screws. Typically the surgeon will drill a small hole to guide it even though its self tapping. At one point got several sets including the drill and bits. What is very surprising is the drill was made of stainless steel and looked a lot like something astronauts would use, but used standard Dewalt battery packs. 😂
Got a couple in my leg and I even got a few broken at home along with the 18” titanium rod they had to remove after those screws broke and started traveling out through my knee.
I had some in my ankle, then I did something stupid and tore it up--they replaced the screws and plates with cadaver bone...but I have one of the long pins that was run through the top of my ankle into my foot for several months, it's like nine or ten inches long. More recently, they did surgery on my spine to remove an infection, and now I'm held together by pins and screws...probably very much like that. I have a couple staples and a staple puller from my back surgery. My wife has similar stuff in her neck. Fun, fun, fun.....
The parts price is quite reasonable compared to the installation fee. I had mine removed too, after the little bump threatened to puncture my skin with most types of shoes. Yes, I kept mine too.
A HUGE part of the cost is the refinement of titanium is a long and tedious process. It’s not a metal that can be smelted and then cast, like steel. Crushed ore must be treated with chlorine to create a slurry which gets baked into essentially a titanium sponge which then must be heated and compressed in an oxygen free environment (Ti at high temperatures is extremely reactive with hydrogen, nitrogen and oxygen) until it’s a solid block.
Its expensive because so few are sold. Its the same with army equipment. You can sell milions of normal screws but only a few thousand of those yet they still gota cover the bill.
