Effect of interfragmentary gap on compression force in a headless compression screw used for scaphoid fixation

Tan, E S; Jais, Ita Suzana Mat; Rahim, Saleem Abdul; Tay, Shian Chao

doi:10.1177/1753193417702565

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…Similar results were found in 2 separate studies that introduced gap size as a variable. Tan et al 22 found that gaps larger than 1 mm led to significant loss of reduction achieved by Acutrak 2 screws. Roebke et al 14 attributed a variety of screw parameters-screw length, pitch differential, length of screw-to their finding that Acutrak 2 screws did not fully reduce and compress 3 mm gaps.…”

Section: Discussionmentioning

confidence: 99%

A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size

Ilyas

Mahoney

Bucklen

2019

Hand (New York, N,Y.)

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Background: There is evidence that interfragmentary fracture gap size may affect the compression achievable with a modern headless compression screw (HCS). This mechanical study compared the compression achieved by 3 commercial HCS systems through various fracture gaps: CAPTIVATE Headless (Globus Medical, Inc, Audubon, Pennsylvania), Synthes (DePuy Synthes, Westchester, Pennsylvania), and Acumed Acutrak 2 (Acumed LLC, Hillsboro, Oregon). Methods: Screws were inserted into a custom test fixture composed of polyurethane synthetic bone foam fragments, separated by a layer of easily compressible polyurethane foam simulating a fracture gap. Compression was measured after final insertion and countersinking. The effect of the interfragmentary fracture gap size on the compression generated was also investigated. Results: The CAPTIVATE Headless 3.0 mm screw (70.1 ± 5.7 N) and the Synthes 3.0 mm screw (64.9 ± 7.3 N) achieved similar compressive forces after final countersink. Similar comparisons were found for the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws, and the CAPTIVATE Headless 4.0 mm and Acutrak 2 Standard screws. The final compression of the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws was not significantly affected when the fracture gap was doubled from 2 to 4 mm, but was reduced significantly by 95.9% with the Acutrak 2 Micro screw. Conclusion: When comparing like-sized screws, the CAPTIVATE, Synthes, and Acutrak 2 HCS systems demonstrated similar potential compressive forces. However, compared with the CAPTIVATE Headless and Synthes HCS systems, which are inserted with a compression sleeve that is not gap distance–dependent, the Acutrak 2 HCS system demonstrated less compression when the simulated fracture gap size was increased to 4 mm.

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Section: Discussionmentioning

confidence: 99%

A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size

Ilyas

Mahoney

Bucklen

2019

Hand (New York, N,Y.)

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“…24,25,28,35 Furthermore, previous biomechanical studies have shown that the fixation properties of the headless screw are comparable or superior to those of the solid or cancellous screws. 15,21,35,36 The Acutrak screw and the Herbert screw are the most widely used headless screws in clinical practice. The specific design features of the Acutrak screw comprise a tapered configuration with a full thread and a variable pitch, while the Herbert screw has a double-threaded design at both ends, achieving simultaneous fixation of both fragments.…”

Section: Discussionmentioning

confidence: 99%

“…4,27 Previous cadaveric studies have shown that the plantar gap widening may induce an unfavorable biomechanical environment for fracture healing. 9,13,34,36 Lee et al 18 treated 75 cases and compared the outcomes between groups with a plantar gap <1 mm and >1 mm. They reported that the mean time to obtain a bone union was significantly shorter in the group with a plantar gap <1 mm.…”

Section: Discussionmentioning

confidence: 99%

“…38,41 With regard to the surgical factors affecting the outcomes of intramedullary screw fixation for fifth metatarsal stress fractures, concerns have been raised in previous studies about the increase in the plantar gap at the fracture site caused by insertion of a straight screw into a curved medullary canal of the metatarsus. 4,9,13,27,34,36 According to the previous report by Lee et al, 18 the plantar gap in fifth metatarsal stress fractures is defined as the distance between the fracture margins on the plantar lateral side of the fifth metatarsal bone on an oblique foot radiograph. Theoretically, an increased gap is an unfavorable phenomenon impairing fracture union.…”

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confidence: 99%

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The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes

et al. 2021

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Background: Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still being investigated. Purpose: To review experiences with intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures in high-level athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively analyzed 37 high-level athletes (Tegner activity score ≥7) who underwent intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures between August 2005 and August 2017. The minimum follow-up period of the patients was 2 years. In assessing the surgical results, time to obtain bone union, time to return to original level of sport participation, and treatment failures/complications were reviewed. Additionally, the effect of intraoperative plantar gap widening caused by the screw insertion was analyzed. The surgical results of the 2 groups, the no-gap group (intraoperative plantar gap widening, <1 mm) and the gap group (intraoperative plantar gap widening, ≥1 mm), were compared, while correlations between intraoperative plantar gap widening and the surgical results were statistically analyzed. Results: Bone union and return to the original sport were attained in all patients without treatment failures/complications such as delayed union, nonunion, or refracture. The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group (n = 16) and the gap group (n = 21), no significant differences in the time to obtain bone union ( P = .392) or to return to sport ( P = .399) were noted. Additionally, there was no correlation between intraoperative plantar gap widening and the time to obtain bone union ( r = 0.131; P = .428) or to return to sport ( r = 0.160; P = .331). Conclusion: The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique.

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“…The pitch of these threads on the head is finer than those on the leading edge thereby generating compression across the fracture line. Whilst these screws have proven to be popular in the internal fixation of intra-articular fractures, notable drawbacks included the surgical exposure required, poor compressive forces and lack of versatility of screw specifications [ 5 , 6 ]. The second generation of HCS was designed to allow greater compression [ 1 ] and cannulated to allow percutaneous fixation.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of headless compression screws versus independent locking screw for intra-articular fractures

Mandala,

Shaunak,

Kreitmair

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Headless compression screws (HCS) have a variable thread pitch and headless design enabling them to embed below the articular surface and generate compression force for fracture healing without restricting movement. Locking screws have greater variety of dimensions and a threaded pitch mirroring the design of the HCS. The objective of this study is to determine whether locking screws can generate compression force and compare the compressive forces generated by HCS versus locking screws. Method A comparison between 3.5-mm HCS versus 3.5-mm locking screws and 2.8-mm HCS versus 2.7-mm locking screws was performed using a synthetic foam bone model (Synbone) and FlexiForce sensors to record the compression forces (N). The mean peak compression force was calculated from a sample of 3 screws for each screw type. Statistical analysis was performed using the one-way ANOVA test and statistical significance was determined to be p = < 0.05. Results The 3.5-mm Synthes and Smith and Nephew locking screws generated similar peak compression forces to the 3.5-mm Acutrak 2 headless compression screws with no statistically significant difference between them. The smaller 2.7-mm Synthes and Smith and Nephew locking screws initially generated similar compressive forces up to 1.5 and 2 revolutions, respectively, but their peak compression force was less compared to the 2.8-mm Micro Acutrak 2 HCS. Conclusion Locking screws are able to generate compressive forces and may be a viable alternative to headless compressive screws supporting their use for intra-articular fractures.

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Effect of interfragmentary gap on compression force in a headless compression screw used for scaphoid fixation

Cited by 6 publications

References 12 publications

A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size

A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size

The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes

Biomechanical comparison of headless compression screws versus independent locking screw for intra-articular fractures

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