We examined the effect of screw-plate angle on the sliding
characteristics and jamming potential of four popularly used
stainless-steel and cobalt-chromium-molybdenum compression hip screws. The
actual coefficient of sliding friction for these alloys was measured in
each device. The force on the screw required to overcome the static
frictional force also was determined, by varying the lengths of screw
engaged in the barrel under conditions of static equilibrium representing
130-degree and 150-degree screw-plate angles. For the 130-degree loading
configuration, this force was significantly (p < 0.001) higher than that
required for the 150-degree loading configuration for all four screw types.
The actual coefficient of friction was relatively constant for each
material, although slight variations due to differences in design between
screw types were found. A positive correlation (p < 0.01) was seen
between the apparent coefficient of friction (the ratio of sliding force to
normal force) and the length of the screw extending from the barrel. All
stainless-steel screws jammed in the 130-degree tests when not completely
engaged in the barrel. None of the 150-degree tests produced jamming and
none of the cobalt-chromium-molybdenum screws jammed in either the
130-degree or the 150-degree test. Examination of jammed devices by
scanning electron microscopy showed galling on the superior surface of both
the screw and the barrel. CLINICAL RELEVANCE: Understanding the conditions
that facilitate sliding of hip screws aids in ensuring their proper use.
The higher the nail-plate angle, the easier it is to impact the
hip-fixation device and thus allow bone impaction and stability at the
fracture site. The potential for jamming a sliding hip screw is decreased
by maximum engagement of the screw in the barrel. Differences in the
material and design of sliding hip-fixation devices have relatively little
effect on the sliding characteristics compared with the nail-plate angle
and the engagement of the screw in the barrel.