The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening

Introduction: Lengthening procedures are often complicated by loosening of pins. It has been reported that coating with hydroxyapatite improves fixation and reduces the rate of pin-track infection. Materials and Methods: We compared 47 hydroxyapatite-coated Schanz screws (HA screws) in 12 monolateral fixators mounted at the University Hospital Hamburg–Eppendorf with 45 standard stainless steel screws in 9 monolateral fixators mounted at the St Josefs-Hospital Wiesbaden by measuring the insertion and extraction torque values. The average implantation period was 7 months for the hydroxyapatite-coated screws and 5.4 months for the uncoated screws. We established the quotient of the maximum extraction torque over insertion torque which shows the change in the fixation strength with respect to time, the fixation index. It eliminates the influence of the varying pin–bone contact. Results: There was no significant difference in the rate of infection. In the Schanz screws without signs of infection the index was 1.92 for the HA screws and 0.76 for the stainless steel screws (P = 0.0002) giving evidence of the improvement of the fixation by the coating. Conclusion: HA coating resulted in improved fixation of Schanz screws in bone and may be useful in prolonged external fixation of the lower leg. The fixation index proved to be a simple tool for the evaluation of the fixation strength of Schanz screws.