Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

A New Fastener With Improved Bone-To-Implant Interface Shows Superior Torque Stripping Resistance Compared With the Standard Buttress Screw

Alfonso, Nicholas A., MD*; Baldini, Todd, MSc*; Stahel, Philip F., MD, FACS*,†

doi: 10.1097/BOT.0000000000001415
Original Article

Objective: The conventional AO buttress screw used for fracture fixation relies on a historic buttress thread design, which is prone to stripping at the bone–implant interface. We hypothesized that a new Bone-Screw-Fastener with an innovative interlocking thread design demonstrates increased resistance to torque stripping forces compared with the buttress screw, without compromising pullout strength.

Methods: A biomechanical model was established in 6 matched pairs of adult human cadaveric tibiae to test torque resistance between the 3.5 mm Bone-Screw-Fastener and the 3.5 mm cortical AO buttress screw until failure. Uniaxial pullout testing of both screw types was performed as an internal control experiment.

Results: The 3.5 mm Bone-Screw-Fastener had a significantly increased resistance to torque failure compared with the standard 3.5 mm AO buttress screw (P = 0.0145). In contrast to the buttress screws, none of the Bone-Screw-Fasteners stripped from the bone but rather failed at the screwdriver–implant interface in terms of a metal-on-metal failure. The internal control experiments revealed no significant difference in axial pullout strength between the 2 implants (P = 0.47).

Conclusions: These data demonstrate the superiority of the new Bone-Screw-Fastener over the conventional AO buttress screw regarding protection from torque stripping forces. In addition, the new thread design that interlocks to the bone does not sacrifice axial pullout resistance conveyed by the buttress screw. Future controlled trials will have to validate the in vivo relevance of these findings in a clinical setting.

*Department of Orthopaedics, University of Colorado, School of Medicine, Aurora, CO; and

Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO.

Reprints: Philip F. Stahel, MD, FACS, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 (e-mail:

Supported by an educational training grant to the Orthopedic residency training program at the University of Colorado School of Medicine by SMV Scientific.

P. F. S. has previously received speaking honoraria, “per diem” allowances, and traveling and lodging reimbursements from the manufacturer of the AO buttress screw investigated in this study (DePuy Synthes, Paoli, PA) and from the AO Foundation.

The remaining authors declared no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted November 14, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.