2D-finite element analyses and histomorphology of lag screws with and without a biconcave washer

For osteosynthesis and for bone transplant fixation in particular, a lag screw with a biconcave washer, the so called "Anchor Screw" (AS) has been introduced in maxillo-facial surgery. Using 2D-finite element analysis (FEA), the v. Mises and the circumferential stresses induced in underlying bone by this AS are analysed and compared to those under a conventional lag screw. The stress distributions below the biconcave washer of the AS were correlated with histomorphological bone reactions after AS osteosynthesis in two tumor patients, retrieved 12 weeks and 19 months after tumor surgery, respectively. Depending on the thickness of cortical bone, the v. Mises stress concentrations below the biconcave washer were lower than under the head of the conventional lag screw (CLS), but with a higher stress maximum concentrated around the rim of the washer. The circumferential stresses were only half as high around the AS, and thus the deformation of bone was reduced. As predicted by FEA, histology showed microcrack formation, but then after minimal resorption, remodelling of bone below the biconcave washer. Stable osteosynthesis could be demonstrated by bony union already after 12 weeks, and, while bone remodelling continued in the healed osteotomy, it had decreased around the screws after 19 months. It can be concluded from the biomechanical principles and the histomorphological findings that the AS appears superior to the CLS.