A COMPARISON OF THE IN-VITRO BIOMECHANICAL PERFORMANCE OF A COMPOSITE BIO-ABSORBABLE SCREW AND CONVENTIONAL METAL SCREWS FOR SCAPHOID FRACTURE FIXATION.

Objective: To compare the ability of a new composite bio-absorbable screw and two conventional metal screws to maintain fixation of scaphoid waist-fractures under dynamic loading conditions. Methods: Fifteen porcine radial carpi, whose morphology is comparable to that of human scaphoids, were osteotomized at the waist. Specimens were randomized in three groups: those in group I were fixed with a headed metal screw, in group II with a headless tapered metal screw, and in group III with a bio-absorbable composite screw. Each specimen was oriented at 45° and cyclically loaded using four blocks of 1000 cycles, with peak loads of 40, 60, 80 and 100 N, respectively. In case of gross failure the number of cycles to failure was determined. Otherwise, permanent displacement at the fracture site was measured after each loading block from a standardized high-magnification photograph using image analysis software (Roman v1.70, Institute of Orthopaedics, Oswestry). Statistical analysis was by ANOVA and tolerance limits. Results: Nogross failure occurred. Average displacements after 4000 cycles up to 100N were 0.05mm±0.03SD (headed metal), 0.15mm±0.16SD (headless metal) and 0.29mm±0.11SD (composite) and differed significantly (p Conclusion: Comparing two types of conventional metal screws and a new composite bio-absorbable screw to maintain scaphoid fixation under cyclic loading conditions, we found small average fracture displacements for all three screws. Moreover, even following severe cyclic loading conditions, clinically meaningful displacements of more than 1 mm are highly unlikely for any of the three screws. We therefore conclude that a new bio-absorbable composite screw can serve as an alternative to conventional screws when fixing scaphoid fractures.