A fatigue life analysis of small fragment screws

Objectives: To conduct a comparative fatigue analysis of several commonly used small fragment screws. Design: Biomechanical laboratory study. Setting: Research laboratory. Main Outcome Measurements: A fatigue life analysis of seven different types of small fragment screws was conducted using a Wohler fatigue-testing machine. Four different types of 3.5-millimeter cortical screws were subjected to fatigue analysis. These included solid stainless steel screws from Synthes Ltd. (core diameter 2.4 millimeters), Zimmer Inc. (core diameter 2.4 millimeter), and Smith and Nephew Richards Inc. (core diameter 2.4 millimeters) and cannulated stainless steel screws from Synthes Ltd. (core diameter 2.5 millimeters). In addition, three types of 4.0-millimeter cancellous screws were tested. These included stainless steel screws from Synthes Ltd. (core diameter 1.9 millimeters), titanium screws from Synthes Ltd. (core diameter 2.0 millimeters), and titanium alloy screws from DePuy-Ace (core diameter 2.8 millimeters). Fatigue lives, as reflected by mean cycles to failure, were compared. Results: The four types of cortical screws had longer fatigue lives than the Synthes cancellous screws did (p < 0.001) but shorter fatigue lives than the DePuy-Ace cancellous screws did (p < 0.0001). Among the cortical screws, the cannulated and solid Synthes screws and the solid Zimmer screws did not differ statistically. The Smith and Nephew Richards cortical screws failed at statistically fewer cycles than the Synthes solid and cannulated cortical screws did (p < 0.003) but did not statistically differ from the Zimmer screws. The DePuy-Ace titanium alloy cancellous screw had the longest fatigue life of the tested implants by a large margin (p < 0.0001). The Synthes pure titanium and stainless steel cancellous screws did not significantly differ. Conclusions: This analysis supports core diameter as the principal factor determining fatigue life as the results paralleled implant geometry. This design modification to improve bending and fatigue strength may come at a price to pullout strength, however, because of a decreased major-to-minor diameter and increased pitch. Cortical screws differed in fatigue performance despite identical dimensions, presumably highlighting the importance of implant processing and machining. Cannulated cortical screws performed well relative to solid screws, thereby supporting their clinical use. Pure titanium and stainless steel cancellous screws performed similarly in fatigue despite differing material properties, presumably because of geometric design differences. This report highlights some of the differences in the in vitro fatigue performance among several commonly used small fragment screws.