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Fixation Methods for Replacement Screws in Scaphoid Fractures: A Biomechanical Study.

Madeline G Tallman1, Akshar H Patel2, Ronald C Anderson1

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|March 28, 2023
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Summary

Replacing headless compression screws leads to significant loss of fixation compression and increased shear displacement. Proper initial screw selection is crucial to avoid these biomechanical issues.

Keywords:
BiomechanicsFractureHeadless compression screwsInternal fixationNonunionScaphoid

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Area of Science:

  • Orthopedic biomechanics
  • Surgical implant technology

Background:

  • Achieving stable fracture fixation is paramount in orthopedic surgery.
  • Headless compression screws are utilized for fracture stabilization, but their removal and replacement can impact biomechanical properties.

Purpose of the Study:

  • To quantify the changes in biomechanical fixation, specifically interfragmentary compression and shear displacement, when a primary headless compression screw is replaced by a secondary screw.
  • To compare the effects of different insertion angles and directions on fixation stability during screw replacement.

Main Methods:

  • A polyurethane foam bone model simulated a fracture site.
  • A 24-mm headless compression screw was inserted, removed, and replaced with a 22-mm screw in various orientations (perpendicular, oblique, same/reverse direction).
  • Compression forces were measured using load cells, and shear displacement was recorded with a digital microscope, followed by statistical analysis.

Main Results:

  • Significant loss of average compression force was observed after replacing the primary screw, regardless of insertion direction or angle.
  • Replacing the screw in the same direction and perpendicular to the fracture plane resulted in a 50 N loss of compression.
  • Greater average shear displacement occurred with oblique screw insertion compared to perpendicular insertion.

Conclusions:

  • Screw replacement, even with varying orientations, leads to a loss of fracture compression.
  • Obliquely inserted screws exhibit increased shear displacement compared to perpendicularly inserted ones.
  • Establishing the correct initial screw length is vital to prevent compression loss associated with screw replacement.