This research project presents a study of the fixation of screws in augmented and non-augmented cancellous bone at a microscopic scale. It is estimated that somewhere close to one million screws are failing each year. Therefore, the aim is to identify the key parameters affecting screw pull-out in order to improve screw fixation in cancellous bone, and hence screw design. The background for this study comes from work by Stryker, comparing screw pull-out from augmented and non-augmented cancellous bone, where a few cases of screw pull-out gave better results without bone augmentation. This is contrary to most evidence and the hypothesis to explain these results is that the screw pull-out from cancellous bone could be strongly affected by the cancellous bone micro architecture. The effect of the influence of the screw’s initial position was first verified with 2D finite element (FE) models of screw pull-out from simplified cancellous bone models. The results showed a force reaction variation up to 28% with small change in position. The hypothesis was then tested with 3D FE models of screw pull-out from more complex cancellous bone models with different volume fractions. Three volume fractions were tested and again the effects were confirmed, but only in models with the lower volume fraction. A variation up to 30% of the force reaction was observed. The 3D simplified cancellous bone models with 5.3% volume fraction were also used to study the influence of augmentation using calcium phosphate cement. A significant improvement of the screw holding power (almost 2 times) as well as an important diminution of the variability of the pull-out force due to the screw initial position was found. Other augmentation geometries were used to model cement. They all showed an increase of the screw pull-out force reaction with an increase of the cement volume. Validation of FE results was achieved by comparing screw pull-out from a cadaver cancellous bone and the FE model constructed from the same bone sample. New studies were then carried out from the cadaver cancellous bone model. The first study examined the screw initial position influence with cancellous and cortical screws and again showed that there is a strong correlation between screw pull-out stiffness and bone volume fraction. The cortical screw showed improved performance over the cancellous screw. Augmentation cases were explored using three bone samples with a range of volume fractions obtained from different sites within the cadaver bone sample. The cancellous screw was tested with 3 types of augmentation and the cortical screw was tested with one augmentation in these 3 samples. The results showed each time a significant improvement of stiffness with augmentation but when compared with the effect of volume variation inside the bone sample, it appeared that the improvement of stiffness from augmentation might not cover the loss in stiffness from a small change in bone structure. Finally, screw design parameters were investigated, as cortical screws seemed to give as good or better stiffness results than cancellous screw. The thread pitch, the thread angle and the core diameter were analysed independently and it appeared that the most important parameter was the thread pitch with an improvement of the stiffness of +46% for cancellous screws with a smaller thread pitch. The two other factors studied (core diameter and thread angle) showed somewhat stiffer results but with a relatively small influence (less than 10%). From this study, the best screw for use in cancellous bone could be a cortical screw (diameter and pitch) with thread angles similar to a cancellous screw.