Partially threaded headless screw may benefit adequate interfragmentary compression and reduced driving torque for small bone fixation

Lin, Chen‐Chiang; Lin, K.M.; Huang, Chih-Hsin; Chen, Wen-Chuan; Wei, Hung-Wen; Tsai, Cheng-Lun; Lin, Kun-Jhih

doi:10.1177/2309499018760130

Cited by 4 publications

(4 citation statements)

References 9 publications

(19 reference statements)

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“…Screws can be partially threaded with threads of different pitches at the proximal and distal aspects of the screw or fully threaded with variable or uniform pitch. 16,17 Partially threaded screws allow for compression across a fracture site by creating a lag effect, while fully threaded, variable pitch screws allow for gradual compression. 18,19 Uniform pitch screws provide no inherent compression or shortening and require a secondary device to provide compression if warranted.…”

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confidence: 99%

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

et al. 2022

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Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.

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confidence: 99%

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

et al. 2022

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“…Minimization of the incidence of potential late deformities and disability with highlevel everyday activity restitution are the main objectives of the surgical treatment. The chosen surgical method must provide stable fracture fixation with reduced supplementary immobilization, early joint mobilization and rehabilitation, therefore reducing the likelihood of elbow stiffness as well as implant related reoperation rates reduction [13] .…”

Section: Discussionmentioning

confidence: 99%

“…In this paper we have presented a novel and alternative ORIF method for medial epicondyle fracture using two 3.5x30 mm fully threaded second generation HCS with the main purpose of overcoming the potential symptomatic screw head prominence or the supplementary immobilization being needed in cannulated screws and K-wires fixation, respectively. The fully threaded headless compression screw design provides stable, rigid interfragment compression fixation as a result of the large thread-to-bone contact area, thus allowing the desired and encouraged early elbow mobilization [7,13] .…”

Section: Discussionmentioning

confidence: 99%

Intra-Articular Medial Epicondyle Avulsion Fracture Entrapment Following Closed Reduction Attempt of Posterior Elbow Dislocation

Petrevski,

Andonovski,

Aleksovski

et al. 2023

AMJ

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Introduction: Pediatric complex elbow dislocations are uncommon injuries as intraarticular medial epicondyle fracture incarceration associated with posterior elbow dislocation occurs in 5-18% of all cases. A high-index of suspicion necessitates a computed tomography (CT) evaluation of the elbow joint as conventional two-plain radiography can be falsely interpreted as normal. The proposed treatment for this type of injury is surgical with multiple techniques being described in the literature.Case report: A fifteen-year-old male presented to our emergency department with left elbow pain, medial elbow region bruising, valgus deformity and decreased range of motion (ROM) of the affected elbow seven hours post-injury. Unsuccessfully closed reduction maneuver at the local hospital with persistent symptoms was followed by CT of the elbow joint with consequent patient transfer to our institution where another closed reduction under appropriate analgesia failed. Urgent open reduction and internal fixation (ORIF) with two second generation 3.5x30 mm fully threaded headless compression screws of the medial epicondyle fracture incarceration was done. The patient was followed-up for three months resulting in laudable patient satisfaction as a result of the painless full range of motion in everyday and sport activities. Conclusion:The imperative in diagnosing this type of injuries in pediatric posterior elbow dislocations following closed reduction attempt is to be aware of its existence. A highindex of suspicion should be further evaluated by CT. ORIF with second generation headless compression screws (HCS) fixation provides a satisfactory functional outcome.

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“…The distal fibula was the lateral structure of the ankle mortise, which was mainly to prevent lateral displacement of the talus, so the distal fibula was important for maintaining the stability of the ankle joint. If the fracture occurred at the distal fibula, the ankle mortise would broaden, as a result, the function of the fibula to the limit the lateral displacement of the talus was lost, [ 12 ] and improper treatment could result in instable ankle mortise and traumatic arthritis. [ 13 ] Therefore, the restoration of the normal anatomical mechanism and force line of distal fibula as well as a reasonable, effective and strong internal fixation were the main principle in treating the distal fibula in ankle fracture operation.…”

Section: Discussionmentioning

confidence: 99%

A retrospective assessment of the clinical efficacy of different internal fixation methods in the treatment of distal fibula fractures in the elderly

et al. 2022

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An ankle fracture is a fracture of the distal tibia or fibula that forms the ankle joint, usually associated with ligament and soft tissue injury, and is a common type of lower limb fracture and one of the most common types of fracture in the elderly. Although ankle fractures are one of the most common injuries seen by orthopedic trauma surgeons, there is no uniform protocol for the diagnosis and treatment of ankle fractures in the elderly, and there are many controversial indications for surgery. The aim of this study is to assess the clinical efficacy of different internal fixation methods in the treatment of distal fibular fractures in the elderly, in an effort to improve the rational selection and application of clinical acts. A retrospective analysis was performed on 68 cases of patients who suffered an ankle fracture and were treated with different internal fixation methods according to the fracture types and individual differences in distal fibula fractures. The postoperative therapeutic effect assessment was performed in terms of clinical examination, imaging evaluation, and AOFAS ankle-hind foot function scoring. There was no unhealed bone, ankle instability and loose/fractured internal fixation. Fracture healing time was 2.7 to 4.0 months (average 3.2 months). AOFAS score was 88.3 ± 6.2, of which, 34 excellent cases, 30 good cases, and 4 fair cases. Ankle activity dorsiflexion 6º~18º, average 15º; plantar flexion 26º~47º, average 37º. A good clinical efficacy could be achieved from the most appropriate individualized internal fixation for distal fibula fractures of elderly patients.

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Partially threaded headless screw may benefit adequate interfragmentary compression and reduced driving torque for small bone fixation

Cited by 4 publications

References 9 publications

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

Intra-Articular Medial Epicondyle Avulsion Fracture Entrapment Following Closed Reduction Attempt of Posterior Elbow Dislocation

A retrospective assessment of the clinical efficacy of different internal fixation methods in the treatment of distal fibula fractures in the elderly

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