Biomechanical Comparison between Preloaded Position Screw and Lag Screw Fixations for Their Compressive Effects in a Porcine Rib Fracture Model.

OBJECTIVES:  The aim of this study was to compare the compressive effect between preloaded position screws and lag screws in fracture fixation.

METHODS:  Pairs of semi-cylindrical bone fragments were created on a porcine rib model to simulate fractured bones. The compressive forces of fracture fixation generated by preloaded position screws (P group) and conventional lag screws (L group) were recorded by a film stress sensor. In the P group, a pair of Angus bone holding forceps was used to compress the interfragmentary interface until reaching the preloading force of 1.3 MPa. Similar preloading procedure was applied on lag screw fixations to explore its potential of additional compressive force.

RESULTS:  With 1.3 MPa preloading force and 0.2 Nm screw insertion torque force, the interfragmentary compressive force of P group was similar to that of L group. When the insertion torque force was increased to 0.4 Nm, all screws in the L group failed due to thread stripping. When screws in the P group were installed under 0.4 Nm torque and in the L group under 0.2 Nm torque, the P group generated significantly greater compressive force. With preloading device applied on lag screw installation, it did not further increase the interfragmentary compressive force.

CLINICAL SIGNIFICANCE:  Compared with lag screws, preloaded position screws tolerated greater torque in screw installation and provided greater interfragmentary compressive force. The study suggests the applicability of preloaded position screws in fracture fixation requiring interfragmentary compression.