An in Vivo Experimental Comparison of Stainless Steel and Titanium Schanz Screws for External Fixation

Abstract

Objective: To compare the clinical benefits of stainless steel (SS) to titanium (Ti) on reducing pin track irritation/infection and pin loosening during external fracture fixation.

Methods: A tibial gap osteotomy was created in 17 sheep and stabilized with four Schanz screws of either SS or Ti and an external fixation frame. Over the 12 week observation period, pin loosening was assessed by grading the radiolucency around the pins and measuring the extraction torque on pin removal at sacrifice. Irritation/infection was assessed with weekly clinical pin track grading. A histological analysis of the tissue adjacent to the pin site was made to assess biocompatibility.

Results: A statistically non-significant trend for less bone resorption around Ti pins was found during the early observation period. However, at sacrifice, there was no difference between the two materials. Also, there was no difference in the extraction torque, and there was similar remodeling and apposition of the bone around the pins. A statistically non-significant trend for more infection about SS pins at sacrifice was found. Histology showed a slightly higher prevalence of reactionary cells in SS samples, but was otherwise not much different than around Ti pins.

Conclusions: There is no clinically relevant substantial advantage in using either SS or Ti pins on reducing pin loosening or pin track irritation/infection.

Keywords: External fixation; Pin loosening; Pin track infection; Stainless steel; Titanium.