Comparative Assessment of the Mechanical Response to Different Screw Dimensions in Scaphoid Fracture Fixation.

The scaphoid is the most commonly fractured carpal bone. Headless compression screws became the gold standard for fixation, but the ideal screw diameter remains debated. This study investigates the relative benefit of using a larger screw diameter to improve stability in typical scaphoid fractures. It also examines the effects of preload and screw length on mechanical behaviour. A finite element (FE) model of a mid-waist scaphoid fracture was created. Screws from Medartis (1.7 mm, 2.2 mm, and 3.0 mm diameter; 23 mm length) were placed along the longitudinal axis. Boundary and loading conditions matched prior studies. Interfragmentary displacement (IFD) and von Mises stress were compared across screw sizes. The effects of screw length and preload were also evaluated. Maximum in-plane IFD was 2.08 mm (1.7 mm screw), 0.53 mm (2.2 mm), and 0.27 mm (3.0 mm). The 1.7 mm screw exceeded the scaphoid's average ultimate stress (60.51 MPa). Increasing preload reduced IFD, especially above 60 N. Screws longer than 1.5 times the mid-waist diameter offered no added benefit. Larger screws provide better biomechanical fracture stability. However, the gain from 2.2 mm to 3.0 mm is minor, while 1.7 mm screws lack sufficient strength. The 2.2 mm screw offers a good balance of stability and bone preservation, making it the preferred choice.