The Effect of Variable-Pitch Headless Compression Screws and Cortical Screws on Interfragmentary Compression: An In-Vitro Polyurethane Foam Block Model

Abstract

Articular fractures require precise anatomical reduction and rigid fixation to heal appropriately. In veterinary cases that involve fracturing of the lateral humeral condyle, cortical bone screws inserted in lag fashion with Kirschner wire are the preferred method for surgical fixation. However, relatively high complication rates associated with cortical lag screws (CLSs) highlights the need to investigate alternate screw designs. Variable-pitch headless compression screws (VPHCSs) are unique as they advance beneath the cortical surface. Although the use of VPHCSs are widely utilised in human orthopaedics, the current use in veterinary orthopaedics is limited. This study aimed to evaluate the peak interfragmentary force (PIF) and area of compression (AOC) generated by a 3.5 mm self-tapping cortical screw placed in lag fashion and a 3.5 mm VPHCS inserted to four depths. PIF and AOC were measured using a pressure-sensitive film placed between two blocks of polyurethane foam (0.24 g/cm3), simulating a transverse fracture. CLS were inserted by hand into predrilled 2.5 mm pilot holes. PIF and AOC were measured at full insertion. VPHCSs were placed into predrilled 2.5 mm pilot holes, followed by a 3.5 mm tapered countersink. The screw was inserted until the head was level with the surface. PIF and AOC were measured between the two blocks. The screw was continued until the head was at a depth of 2, 5, and 9 mm below the surface, and the PIF and AOC were measured again at each stage. There was no detectable difference in PIF and AOC between CLSs and VPHCSs countersunk to −2 mm (PIF–CLS: Mean= 12.886, SD= 2.370; 2 mm: Mean= 17.301, SD= 8.858, p = 0.319; AOC–CLS: Mean= 0.936, SD= 0.291; 2 mm: Mean= 0.925, SD= 0.447, p = 0.872). VPHCSs countersunk to −5 mm and −9 mm produced significantly greater PIF compared to CLSs (5 mm: Mean= 16.086, SD= 6.799, p = 0.002; 9 mm: Mean= 34.987, SD= 4.015, p < 0.001). VPHCSs countersunk to −5 and −9 mm produced significantly greater PIF and AOC compared to CLSs in this model. Further investigation is required to produce recommendations for clinical use.