A comparison of fixation screws for the scaphoid during application of cyclical bending loads

Matched pairs of scaphoids from cadavera were stressed with ramped intensity cyclical bending loads after osteotomy and fixation of one scaphoid with a Herbert screw and fixation of the other with an AO 3.5-millimeter cannulated screw, a Herbert-Whipple screw, an Acutrak cannulated screw, or a Universal Compression screw. The AO screw, Acutrak screw, and Herbert-Whipple screw demonstrated superior resistance to cyclical bending loads compared with the Herbert screw. The Universal Compression screw did not provide better fixation than the Herbert screw because of fractures that occurred at the time of insertion. The AO screw and the Herbert screw were then tested in a separate setup in which a segment of volar cortex had been removed in addition to the simple osteotomy. The loss of volar cortex greatly diminished the quality of the fixation provided by both of the screws during application of ramped intensity cyclical bending loads.

A fixation device in the scaphoid must be able to withstand the stresses that are placed on the scaphoid as a result of its position spanning the proximal and distal carpal rows. Also, because of the prolonged time required for healing of fractures or non-unions of the scaphoid, the device must be able to withstand many such cycles of stress. The present study demonstrates that commonly used screws for fixation of the scaphoid vary significantly (p < 0.005) in their ability to resist cyclical bending loads.