Broken Screws Research Articles

Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated

The aim of this study was to examine the results of minimally invasive plate osteosynthesis (MIPO) of the femoral shaft fracture in patients where intramedullary nailing is contraindicated and evaluate the proper number of the screws for stable fixation. This was a retrospective study of 36 closed femoral shaft fractures which underwent MIPO using a conventional 4.5 broad dynamic compression plate (DCP) with 14-18 holes fixed with three or four screws in the proximal and distal fragments. Thirty-three fractures had bony union in 21.0 weeks (range, 12-28 weeks), two had delayed union that required bone graft and union at 28 and 32 weeks. Malalignment occurred in five cases. Sixty-two fragments were fixed with three screws--40 in cluster and 22 in separated positions. Ten fragments were fixed with four screws--eight in cluster and two separated. Broken screws were found in three cases; all were in the group with three screws fixed in cluster group. MIPO of the femoral shaft fracture is an alternative treatment in the patient where intramedullary nailing is contraindicated. Malalignment is the common complication that must be carefully evaluated intraoperatively. We recommend using at least three separated screws in each fragment to reduce the risk of screw breakage.

Der Fixateur interne bei nicht-traumatischen Indikationen in der Wirbelsäulen-Chirurgie

This series includes 59 consecutive patients, 51 of whom had a minimum follow up of 2 years. The diagnosis was mechanical instability in 39, deformity in 11, and infection or tumor in 9 patients. The overall clinical results of the total group were good or fair in 88% of the patients. Pseudarthrosis occurred twice. We had on postoperative infection, one persistent and two reversible neurological complications. We found 13 broken screws and one rod breakage which had no clinical relevance. None of these asymptomatic complications required revision. The internal fixator has a great potential of correction in scoliotic and kyphotic deformities of the spine. It has not been shown to have the same potential in spondylolisthesis. A combined anterior and posterior stabilisation is needed in severe spondylolisthesis. We have found the internal fixator to provide satisfactory stability to allow fusion and good clinical results with a low rate of relevant complications.

Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system

Secure fixation of displaced proximal fractures of the humerus is a challenging problem. A total of 32 patients with acutely displaced three- or four-part proximal fractures of the humerus were treated by open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate. There were 23 women and nine men with a mean age of 59.9 years (18 to 87). Data were collected prospectively and the outcomes were assessed using the Constant score. The mean follow-up was for 11 months (3 to 24). In 31 patients (97%) the fracture united clinically and radiologically at a mean of 10 weeks (8 to 24). The mean Constant score at final review was 66.5 (30 to 92). There was no significant difference in outcome when comparing patients aged more than 60 years (18 patients) with those aged less than 60 years (14 patients) (t-test, p = 0.8443). There was one case each of nonunion, malunion and a broken screw in the elderly population. This plate provides an alternative method of fixation for fractures of the proximal humerus. It provides a stable fixation in young patients with good-quality bone sufficient to permit early mobilisation. Failure of the screws to maintain fixation in the elderly remains a problem.

Revision Total Hip Arthroplasty for Pelvic Discontinuity

Revision of a failed total hip arthroplasty with massive acetabular bone loss and pelvic discontinuity is a reconstructive challenge. This report presents the mid-term to long-term results of revision total hip arthroplasty with a custom-made porous-coated triflange acetabular prosthesis in a consecutive series of patients with pelvic discontinuity. Twenty-eight consecutive patients (thirty hips) with a failed total hip arthroplasty and pelvic discontinuity underwent revision total hip arthroplasty. The prosthesis was custom-manufactured on the basis of a three-dimensional model of the hemipelvis created with computed tomography. Initial stability of the implant was provided with screw fixation. Two patients did not return for follow-up after three months, and eight died and were followed for less than seven years, leaving twenty hips in eighteen patients followed for a mean of ten years. Harris hip scores and sequential radiographs were used to evaluate the clinical and radiographic results. Definite healing of the pelvic discontinuity was indicated by the presence of bridging callus in eighteen of the twenty hips. There were no broken screws and no cases of implant migration, even when the discontinuity persisted. Small nonprogressive radiolucent lines were observed in six hips. Complications included one partial sciatic nerve palsy that resolved completely and one case of loose ischial screws in a radiographically stable implant in the same patient. Five patients had one or more dislocations postoperatively. The mean Harris hip score improved from 41 points preoperatively to 80 points at the time of the latest follow-up. Eleven of the eighteen patients required ambulatory aids postoperatively. No component was revised. Performance of a revision total hip arthroplasty with a custom triflange acetabular prosthesis to treat massive acetabular bone loss and pelvic discontinuity can provide a durable solution with good clinical results. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Open Fractures of the Tibia Treated by Immediate Intramedullary Tibial Nail Insertion Without Reaming: A Prospective Study

Does immediate tibial nail insertion without reaming as part of protocol-driven management provide a safe and effective treatment for open tibia fractures? Prospective cohort. Level 1 trauma center. A consecutive series of 161 patients with Gustilo grade I-IIIb open tibia fractures. Emergent incision and debridement of the wound with immediate tibial nail insertion without reaming, repeat incision and debridement, and soft-tissue coverage within 14 days. Time to union, number of secondary procedures performed to obtain union, implant failures, and the type and incidence of complications. One hundred and forty-three fractures were followed to union. Follow up averaged 2.2 years (0.6-5.5 years). Seventy-six fractures united in less than 6 months, 35 took between 6 and 9 months, and 32 took longer than 9 months. Twenty-five additional procedures were needed to obtain union in 16 of the delayed unions (12 nail exchanges, 4 bone grafts, 9 dynamizations). Complications included 3 patients with cellulitis, 1 superficial infection, 4 deep infections (1 grade I, 2 grade II, 1 grade IIIb), 3 loose screws, 2 broken screws, 5 malunions greater than 5 degrees, and 30 patients with decreased ankle motion when compared with the uninjured side. Not counting the ankle loss of motion, 18 complications occurred in 143 fractures (13%). Twenty-nine patients (20%) had complaints of minor knee pain and 30 (21%) had occasional fracture site pain after activity despite clinical and radiographic evidence of union. Eleven patients (8%) considered themselves completely disabled. Five patients were not treated by the standard protocol and are not included in the previously listed statistics; 3 were grade IIIB that did not have adequate coverage by 14 days, and 2 were grade II injuries that did not have a second debridement. Four of these 5 patients developed a complication. Protocol-driven management emphasizing meticulous soft-tissue management and the use of immediate tibial nailing without reaming appears to be safe and effective in the treatment of open tibia fractures. The deep infection rate for the patients who were treated by protocol was 3% and the implant failure rate was lower than has been previously reported, most likely attributable to attempts to obtain cortical contact and avoid fracture gaps. Overall satisfaction was good, but approximately 41% of the patients had complaints of knee or fracture site pain or both well after union.

Complications of circular plate fixation for four-corner arthrodesis

Four corner arthrodesis is an accepted salvage operation for scapholunate advanced collapse and scaphoid non-union advanced collapse. Circular plates were introduced in 1999 and promoted as a rapid and more stable method for this procedure. A retrospective chart review was performed on all patients who were treated with the Spider Limited Wrist Fusion Plate (Kinetikos Medical Inc., San Diego, CA). Sixteen patients were identified and followed clinically and with X-rays for an average of 16 (range 5-38) months. Nine out of the 16 patients (56%) had complications, including non-union (25%), delayed union (6%), dorsal impingement (25%), radial styloid impingement (6%) and broken screws (13%). The purpose of this study was to compare our complication rate using circular plates with published outcomes using traditional methods of fixation: this study identified a significantly higher complication rate and lower union rate using circular plate fixation for four-corner arthrodesis compared with previously published techniques.

Comparison of Pelvic Fixation Techniques in Neuromuscular Spinal Deformity Correction: Galveston Rod Versus Iliac and Lumbosacral Screws

Retrospective radiographic and clinical review. To evaluate the safety and efficacy of iliac screws as a method of pelvic fixation in neuromuscular spinal deformity correction using the Galveston rod technique as a comparison group. Sacropelvic fixation in patients with neuromuscular spinal deformity has traditionally used Galveston rods placed into the iliac wing. Difficulties with radiographic halos around the rods (loosening), rod contouring, and attaching to lumbar spine anchors have prompted their replacement with iliac screws. A minimum 2-year radiographic and clinical follow-up compared 20 patients with the Galveston technique to 20 patients with an iliac screw undergoing posterior spinal fusion (T2/T3-pelvis) for neuromuscular spinal deformity. All patients with the Galveston technique had sublaminar wires for their lumbar anchors, while the majority of patients with an iliac screw technique had at least 2 lumbar and/or sacral screws placed in addition to the iliac screws. There were no significant differences between the 2 groups in preoperative, postoperative, and latest follow-up (mean 3.1 years) measurements for coronal Cobb measures, coronal and sagittal C7 plumblines, and T1 offset. Pelvic obliquity was similar in both groups preoperatively (22 degrees) but at latest follow-up was statistically improved in the patients with an iliac screw (4.4 degrees) versus those with the Galveston technique (7.3 degrees) (P = 0.04). There were 13 patients with the Galveston technique versus 6 with an iliac screw who had radiolucent halos more than 2 mm around the pelvic anchor devices at latest follow-up (P < 0.05). The Galveston technique group had 4 broken rods and 2 reoperations, while the iliac screw group had 1 broken screw and no reoperations. Using iliac screws for pelvic fixation in neuromuscular spinal deformity affords equivalent maintenance of pelvic obliquity and scoliosis correction compared to the Galveston technique. Furthermore, the iliac screw technique avoids complex, lumbosacral 3-dimensional rod bends and yields minimal implant complications.

Flexible Intramedullary Nail Removal Using a Broken Screw Removal Set

The use of flexible titanium intramedullary nails for management of pediatric long bone fractures and some adult fractures has become common. Nail removal after union can be challenging and often requires a larger exposure than nail placement to allow the insertion of grasping devices, such as pliers. A percutaneous technique for the removal of flexible intramedullary nails using extraction bolts from a broken screw removal set is presented. The technique is especially useful when the end of the nail is not prominent and where a hollow reamer from the same set can expose the nail end for the extraction bolt to be used.

Mode of Fixation Failures of Dynamic Hip Screw with TSP in the Treatment of Unstable Proximal Femur Fracture: Biomechanical Analysis and a Report of 3 Cases

There are few reports of the failure mode of a dynamic hip screw with a trochanteric stabilizing plate (TSP) in the treatment of unstable proximal femur fractures. We present 3 cases of fixation failure of a TSP used to treat unstable intertrochanteric fractures. All cases had the same type of failure mode, which represented a fatigue fracture of the distal screw at the junction of a plate and screw. Non-union occurred in 2 cases, and one case was an incidental finding 4 years after union. Biomechanical analysis and SEM (scanning electron micrograph) examination was also performed. Adding TSP to the plate might increase the level of shear stress and slip motion in the distal screw followed by a fatigue fracture. SEM of the surface of the broken screw revealed a multiple cycle and low stress fatigue fracture. Recommendations are made regarding the implant design and surgical technique.

Dorsal Modified Calcaneal Plate for Extensive Midfoot Arthrodesis

Extensive midfoot fusions can be challenging because of bone loss, deformity, and soft tissue anatomy. Several options have been advocated, including multiple screw fixation, medial plating, and plantar plating. We report a new technique using a dorsally-placed, modified calcaneal plate for treatment of this difficult clinical problem. Patients undergoing extensive (more than four joints) midfoot arthrodeses with a dorsally-placed, modified calcaneal plate between 2000 and 2003 were retrospectively reviewed. Diagnoses included Charcot arthropathy (four), osteoarthritis (two), posttraumatic osteoarthritis (two), massive bone loss from previous infection (one), and residual clubfoot deformity (one). Patients with active midfoot infections were excluded. During the study period, midfoot arthrodeses with a dorsal calcaneal plate were done in 10 patients. Of these, nine patients were available for review. Arthrodeses were attempted in 62 joints in these nine patients. Autogenous grafting was used in three patients (23 joints), allograft was used in six patients (39 joints). Patients were maintained nonweightbearing until radiographs or computed tomography conclusively showed union. One of the 10 patients died from an unrelated cause. In the nine remaining patents, 95% (59 of 62) of joints fused within 4 months of surgery. Postoperative complications included nonunion with broken screws in one patient, and three wound problems successfully treated with local dressings. Secondary procedures included one revision arthrodesis and two hardware removals. Patient satisfaction with this procedure was very high (eight of nine). The use of a dorsal calcaneal plate is a viable method of fixation for achieving fusion in extensive midfoot arthropathy. The plate is low-profile and easily moldable to conform to dorsal midfoot anatomy. It can be placed without extensive plantar or medial foot dissection and maintains midfoot alignment until bony fusion occurs. In patients with complex midfoot pathology requiring multijoint fusions, the results have been satisfactory.

MECHANICAL STRENGTH AND OPTIMAL SITE OF PLACEMENT OF A THREADED BONE SCREW ASSESSED ON THE BASIS OF THE SCREW BREAKAGE FOR NON-UNION OF THE SCAPHOID: A BIOMECHANICAL STUDY

We have performed the surgical procedure on the patients with the fracture of the scaphoid using mini-acutrak screws (ACUMED, Inc.). A 25-year-old man was injured in a fall. Surgical treatment for non-union of the scaphoid using a mini-acutrak screw was performed. However, this screw was broken, despite the absence of any obvious trauma mechanism. A structural examination was performed with a metal microscope and a hardness test was performed. A hardness evaluation was conducted on this broken screw and similar screws. Cannulated screws having diameters of 2.7 and 3.5 mm were also evaluated in the strength test as controls for comparison. The breakage of screw occurred due to fatigue. The screw provides the strength equivalent to that of a 3.5 mm cannulated screw but the bending strength of the head end portion in which the breakage occurred was assumed to be the strength of about one-third that of the intermediate portion.

橈骨近位骨幹骨折をプレート固定した子馬の1症例

A complete fracture of the radial proximal metaphysis in a one-month-old Thoroughbred colt was successfully repaired by means of two bone plates. An incision was made between the extensor carpi radialis and the common digital extensor muscle. Then a 10-hole narrow plate was fixed in place on the cranial side and a 12-hole broad plate on the lateral side of the radius. A full-limb cast was applied for 3 weeks. The lateral plate and cranial plate was removed 6 weeks and 10 weeks after surgery, respectively. At the time of plate removal, we observed 2 broken screws, slight misalignment, and severe callus formation at the fracture site. Such initial gait abnormality as radial nerve paralysis was gradually resolved. Fifteen months later, the horse was put on sale and purchased. It won its debut race three years and four months after the injury.

Internal splinting of dorsal intertarsal and tarsometatarsal instabilities in dogs and cats with the ComPact UniLock 2.0/2.4TM System

SummaryDorsal intertarsal and tarsometatarsal instabilities are considered to be uncommon in dogs and only a few cases have been reported in cats. Treatment usually consists at partial arthrodesis. Internal splinting of the affected joints represents an alternative surgical method, with the goal of preserving joint function. In the present study, 13 animals (10 cats and 3 dogs) with dorsal, dorsomedial or dorsolateral intertarsal or tarsometatarsal instabilities, treated with an internal fixator (ComPact UniLock 2.0/2.4™ System) in bridging function, were reviewed. The joint cartilage was left intact. Follow-up time ranged from one month to one year postoperatively. The clinical outcome was considered good or excellent in 12 of the animals and moderate in one cat. The implants were removed from three patients. Follow-up radiographs were available for 10 cases. Joint space narrowing, or joint fusion, occurred in three cases. A broken screw each in one cat and one dog did not affect the stability of the joints involved. The technique described is simple and less invasive than partial arthrodesis and results suggest it as being a valuable alternative to partial arthrodesis. Early implant removal might possibly prevent cartilage damage and joint fusion due to prolonged immobilization.

Sonography of the postoperative shoulder

The surgically operated shoulder can be evaluated for residual or recurrent disease by the different radiologic modalities including conventional arthrography, CT arthrography, MR arthrography, and musculoskeletal ultrasonography (MSUS). Ultrasound offers a non-invasive and accurate method of visualizing the integrity of the surgerized rotator cuff. Post-operative changes such as troughs, anchors, and bioscrews can be visualized with MSUS. Cuff re-tears after surgery can be correctly diagnosed. Recurrent cuff tears are often seen as an “all-or-nothing” phenomenon, with total dissolution of the cuff. Metachronous tears can be localized in relation to the surgical site. Fixation failures, such as detaching anchors or broken screws, can be evaluated in dynamic real time to confirm their instabilty and complications such as impingement or infection.

Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated blade plate.

Nonunion of distal tibia metaphyseal fractures after trauma is a major problem. Treating these nonunions is made more challenging by the presence of symptomatic ipsilateral tibiotalar arthrosis. The current study examined the use of the 90 degrees cannulated blade plate as an alternative method of stable internal fixation for 13 distal tibia metaphyseal nonunions and simultaneous fusion of three arthritic tibiotalar joints in 13 patients (seven males and six females) with an average age of 42.4 years (range, 21-73 years). Each patient had an average of three prior procedures (range, 2-6). Patients were followed up for an average of 34.2 months (range, 24-55 months). All 13 patients achieved radiographic and clinical union an average of 15.6 weeks (range, 12-20 weeks) from the date of the definitive procedure. There were two broken screws, but no secondary procedures were required to obtain fusion. All patients were ambulatory without support at the last followup. The implant proved effective for stable internal fixation of distal tibia metaphyseal nonunions alone or with simultaneous fusion of the tibiotalar joint.

Clamps Recalled for Broken Screw

Clamps Recalled for Broken Screw

Premature biomechanical failure of the distal fixation screws of the IC Nail—case report

Treatment of closed fractures of the tibial shaft by intramedullary nailing has become standard practice [1]. However, broken implants such as a plastic medullary tube [2] or a broken nail or broken screws can occur either intraor postoperatively. This is a report of a case of premature failure of the two distal screws of the IC Nail in a patient with fractured distal third of the tibia. Although bony healing was prompt after the application of compression, it was noted that one of the two distal screws was significantly bent. Compression was applied immediately after the operation by the method recommended by the developers of the IC Nail1. Serial follow up showed early breakage of the bent screw, and bending of the other remaining distal screw as well. The opportunity is taken to discuss the biomechanical basis of the early failure of the two distal screws, and the necessary precautions needed in the use of the IC Nail are highlighted.

Thoracic pedicle screw instrumentation using the "Funnel Technique": part 2. Clinical experience.

This study is a retrospective review of the clinical results of patients treated with thoracic pedicle screws using the "funnel technique." The objective is to report the clinical results of patients treated with thoracic pedicle screws using the funnel technique for screw placement. A total of 115 patients treated with the use of at least one thoracic pedicle screw were retrospectively identified. All patients were treated at a single medical center, under the senior author's supervision. Twenty-five different residents were responsible for placing 50-60% of these screws, and five different fellows and the senior author placed the remainder. The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing intraoperative and postoperative charts and radiographs. There were 115 patients (age range 9-82 years) with the average follow-up period of 17 months. The total number of screws used was 348; the screw diameter ranged from 4.0 to 7.75 mm. There were no vascular or pulmonary complications. There was no iatrogenic neurologic injury, except for one patient who developed a transient anterior thigh numbness from intraoperative positioning. In fracture patients, 35% (10 of 28) had documented neurologic improvement postoperatively. There were no obviously misplaced pedicle screws on detailed review of intraoperative and postoperative radiographs. No screws had to be electively removed for complications related to misplacement. There were four broken screws, one broken rod, two loose screws, and three connector disengagements. Two patients had deep infections and four patients had pseudarthrosis requiring additional surgery. The clinical results proved that thoracic pedicle screws can be safely placed with the funnel technique.

Removal of broken pedicle screws. Technical note.

The authors describe a simple, new method for removing broken pedicle screws. Under microscopic visualization a straight, narrow slot is etched in the broken surface of the pedicle screw by using a power drill with a 2-mm diamond burr. A minus screwdriver is then inserted into the slot, and the broken screw is rotated and removed. There is no need to enlarge the screw hole around the broken screw or to use any special devices. The authors succeeded in removing broken screws in two cases, and there were no complications. This method allows preservation of both the pedicle and the screw hole. Consequently, it is possible to insert new pedicle screws into the same hole without losing the strength and stability of pedicle screw fixation. The authors recommend this simple and new method for removal of broken pedicle screws.

The initial fixation of the press-fit acetabular shell--clinical observation and experimental study.

The initial solid fixation of an uncemented acetabular component affects the amount of bone ingrowth. We had several problems with broken screws in cases of acetabular revision. In recent years, the development of uncemented components without screws has attempted to improve these problems. We started to use "press-fit"-type acetabular shells in November 1996. Our thirty cases undergoing 2 mm under-reaming show good initial stability. The aim of our biomechanical study was to assess the most suitable degree of under-reaming of the bony acetabulum for the implantation of an uncemented hemispherical porous coated component.