Fine thread versus coarse thread. A comparison of the maximum holding power

For osteosynthesis in the epiphyseal region of long bones, specialized screw types are available to achieve a better purchase in cancellous bone. Typically, the cancellous bone screw has a large outer thread diameter with a relatively small core diameter and a great pitch. Due to its dimensions, this screw type is not suited for the cancellous bone areas in hand and foot surgery, respectively. Fine machine screws are better adapted to the bone dimensions in this part of the skeleton. To compare the holding power of fine machine screws with the holding power of other screw types available in the market, a biomechanical study was undertaken. Different screw types were compared: 4 mm cancellous screw, 3.5 and 2.7 mm cortical screws and three different diameters of a fine machine screw (2.2, 1.6 and 1.2 mm). Both cortical screws were tested in pretapped and self-tapping version. Polyurethane foam and bovine cancellous bone were tested. The screws were applied according to the manufacturer's instructions and an axial extraction force was applied. The 4 mm cancellous bone screws were superior to all the other screws in both test materials (P<0.05). The 3.5 mm cortical screw showed a significant difference compared to the 2.7 mm cortical screw in both materials. A significant difference between the self-tapping and pretapped screws of the same diameter was only found in the 3.5 mm cortical screws in polyurethane foam (P<0.05). Interestingly, the maximum holding power of the 2.2 mm fine machine screws in homogeneous test material (polyurethane foam) was as high as the holding power of the 2.7 mm cortical screws (P<0.05). In natural bovine cancellous bone, the result was even more striking. There was no significant difference between the 2.2 mm fine machine screws and the 3.5 mm cortical screws (P<0.05). Relative to their thread diameter, the fine machine screws were superior to conventional cancellous and cortical screws in cancellous bone. The high holding power of this screw type is at least partly due to the impaction effect of the drilling debris between the thread and the abutting spongy bone structure.