Effects of Removal and Reinsertion of Headless Compression Screws

J Hand Surg Am. 2018 Feb;43(2):139-145. doi: 10.1016/j.jhsa.2017.10.002. Epub 2017 Nov 11.


Purpose: This study investigates the loss of compression when 3 commonly used headless compression screws are backed out (reversed), and assesses the ability to re-establish compression with screws of greater diameter.

Methods: Two investigators tested 3 screw designs (Acutrak 2, Synthes HCS, Medartis SpeedTip CCS) in 2 diameters and lengths. Each design had 10 test cycles in a polyurethane foam bone model with compression recorded using a washer load cell. A 28-mm screw of the narrower diameter was inserted until 2 mm recessed and then reversed 30°, 60°, 90°, 180°, 270°, 360°, and 720°. After this the screw was removed completely and a 24-mm screw of greater diameter inserted until recessed 2 mm with the compressive force again recorded.

Results: All screws showed an immediate, statistically significant loss of compression at 30° of reversing. The Acutrak 2 Micro screw demonstrated not only the greatest mean compressive force, but also the fastest compressive loss. Insertion of the shorter screw of greater diameter was associated with re-establishment of compression to levels comparable with the original screw.

Conclusions: This study reaffirms the importance of establishing the correct screw length before insertion due to the immediate loss of compression with reversal of these devices.

Clinical relevance: If a headless compression screw penetrates the far joint surface, the screw should be completely removed and replaced with a shorter screw of greater diameter.

Keywords: Headless compression screw; loss of compression; reversal.

MeSH terms

  • Bone Screws*
  • Compressive Strength*
  • Fracture Fixation, Internal / instrumentation
  • Humans
  • Models, Biological
  • Prosthesis Design*
  • Prosthesis Failure*