Cannulated Cancellous Screw Research Articles

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Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow.
 Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children.
 Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al.
 Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022).
 Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

Pott’s fracture: Study of functional outcomes of various surgical treatments

Background: Pott’s fractures are very common in ankle injuries because of increased incidence of road traffic accidents and industrial trauma. Anatomical reduction and stable fixation is important for a painless ankle joint. Aim & Objectives: To study functional outcomes of various surgical treatments of pott’s fracture; to achieve stable fixation and early mobilization of the ankle.Materials and Methods: We have evaluated clinical, radiological and functional outcomes of 30 patients treated with different treatment modalities, which include - tension band wiring (TBW), Kirschner (K)-wire, malleolar screw (MS) and cannulated cancellous screws (CCS) for medial malleolus fracture and rush nail, one-third tubular plate, fibular locking plate for lateral malleolus fracture.Results: In this prospective study, 30 cases of Pott’s fractures of ankle were treated by different surgical method. Most common mode of injury was pronation and external rotation injury accounts for 53.34%. 29 cases were treated with open reduction internal fixation and one case associated with plafond fracture treated with external fixator. 15cases of medial malleoli fracture treated with TBW and 14 cases with malleolar / cannulated cancellous screw. Lateral malleoli fractures were treated with rush nail/ fibular plate. We found excellent results in 17 cases, good results in 8 cases, fair results in 4 cases and poor result in 1 case.Conclusion: In this study, after analysing our result, clinical and radiological results has been compared with other published result and found that TBW and fibular plate give excellent results.Level 1 Evidence: Prospective study

Functional outcome of distal radius fractures treated with fixation by percutaneous cannulated screw

<p class="abstract"><strong>Background:</strong> In the present study primary objectives were to evaluate the clinical and functional outcome and union rates, whereas secondary objective was to study complications associated with closed reduction percutaneous fixation of displaced unstable fractures of distal radius in adults by using cannulated cancellous (CC) screw.</p><p class="abstract"><strong>Methods:</strong> Thirty two patients aged more than 18 years, with unstable displaced distal radial fracture were included in this prospective observational study. Patients were treated by closed reduction and percutaneous fixation by CC screw. Radiological parameters like radial inclination, radial height, ulnar variance, volar tilt were measured. Mayo wrist score and range of motion were noted. Patients were followed up for six months. Continuous variables were compared by using paired and unpaired ‘t’ test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean Mayo wrist score at six months post-operative follow-up (82.8) was significantly higher compared to six weeks post-operative follow-up (64.4). Mean early post-operative radial height, mean radial inclination, and mean volar tilt were significantly higher compared to mean six months post-operatively. Mean early post-operative ulnar variance was significantly lower compared to mean six months post-operatively. Mean flexion, mean extension, mean supination, mean pronation, mean radial deviation, and mean ulnar deviation was significantly higher six months post-operative follow-up compared to six week post-operative follow-up. Mean grip strength was significantly higher six months post-operative follow-up compared to six week post-operative follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Clinical and functional outcomes associated with closed reduction and percutaneous fixation by cannulated cancellous screw was excellent. Mayo wrist score was increased over six months follow up period.</p>

Management of fracture neck of femur with internal fixation alone or with fibular graft

Introduction: This study was conducted to assess the results of using free fibular graft to augment fracture fixation with cannulated cancellous screw for femoral neck. Methods: The present study includes 15 cases of fracture neck of femur in elderly patients of the age 20-60 years irrespective of sex treated by Close / Open Reduction and Internal Fixation Using DHS / AO Cannulated Cancellous Screws Along With Strut Fibular Graft in the Department of Orthopaedics At PMCH Patna.Results: 15 cases of fracture neck of femur were taken up for the study who reported to department of orthopaedics, PMCH between the ages of 20 – 60 years. The minimum duration between occurrence of fracture and surgical intervention was 3 weeks. Conclusions: This technique is an ideal treatment for patients with neglected intracapsular neck of femur in younger age group in our part. Firstly our results were encouraging and secondly this fracture is cost effective and thirdly technically less demanding and lastly associated with good outcome allowing them to resume pre-fracture activities.

Four Screws Diamond Configuration Fixation for Displaced, Comminuted Intracapsular Fracture Neck Femur in Young Adults.

Background:Four cannulated cancellous screws (CCS) in diamond configuration have been recommended by some authors for fixation of intracapsular neck of femur (ICNF) fracture with posterior comminution in adults. This is also supported by biomechanical studies. However, the clinical usefulness of this biomechanical advantage is not known. This study evaluates the outcomes of displaced, comminuted ICNF fracture in young adults managed by four CCS fixation in diamond configuration.Materials and Methods:25 patients who met the inclusion criteria were operated during the study period. Four patients were lost to followup in the first 6 weeks postoperatively, and one patient died in first 6 months of followup unrelated to surgery. Thus, twenty patients were followed up for a mean period of 33.3 months (range 25–38 months). In all patients, fracture fixation was done with four CCS in diamond configuration. Union at fracture site and avascular necrosis (AVN) of femoral head was assessed on serial plain radiographs. Functional outcome was evaluated by Harris hip score.Results:Eighteen patients had union, two patients had nonunion, and two patients had AVN of femoral head. All the sixteen patients who had union without AVN had good or excellent functional outcome.Conclusions:The present study concludes that four CCS fixation in diamond configuration appears to be a reasonable choice of fixation for displaced fracture ICNF with comminution in young adults. However, further evaluation with better study design and larger patient population is required for definite conclusions.

Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Background: Intertrochanteric Femur fracture is common in elderly patient with co-morbidity.Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Aims and objectives; we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Study Design: This is a prospective observational type of study Place and duration of study: Department of orthopaedics, NHL medical college between January 2015 to June 2018 Methodology: 52 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2015 to june 2018. We included those patients having age ≥50 years, with multiple co- morbid conditions like diabetes, hypertension, COPD, Asthma, bleeding disorders and multiple fractures, and duration of the Intertrochanteric fracture ≤ two week. We exclude young active patients < 50 yrs age, fracture > 2 weeks duration, fracture with lateral wall comminution and open fractures. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results; All the fractures were united within an average period of 13 weeks with a range of 10 – 13 weeks. The functional assessment was done with modified Harris hip score(Table no 1,2) and the mean was 86.3 with a range from 73 to 95 , and 26 patients were excellent, 20 patients were good , 4 patients were fair and two patients were poor with respect to total score. The analysis of this study fulfils the objectives of good functional outcome Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications. Keywords: Compression screw, Ender nails, osteoporosis, inter-trochanteric fracture

From the Editor’s Desk

We thank authors for their contribution in the July-December 2020 issue of Trauma International. This issue contains articles on operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate, Relationship between Vitamin D Level and Hip Fractures, Tranexamic Acid in an Accident & Emergency Department, Chronic osteomyelitis, Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture, Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture, Tibial Plateau Fractures. We appreciate efforts of the author s and hope for more contribution in the field of orthopaedic literature in the coming years.

Clinical experience with management of Hoffa fractures using headless compression screw and headed screw

Purposeto analyze the radiological and functional outcomes of patients after surgical treatment of coronal plane fractures of femoral condyle using headless compression screw and cannulated cancellous (CC) screws (headed screws). Material and methodIn this prospective study 30 cases were included, out of which 15 were treated with headed screws and other 15 were treated with headless screws. Active knee mobilization exercises were started from the third postoperative day. Initially, patients were kept non-weight bearing; partial weight bearing was started at 10 weeks and progressed to full weight bearing as tolerated. Follow-up visits conducted at 2, 4 and 12 weeks, thereafter at 6 and 12 months. The long term final results were rated using Neer's rating system. ResultsResults were graded as excellent (score > 85), Satisfactory (score 71–85), Unsatisfactory (score 56–70), and Failure (score < 55). In CC screw group the outcome was good in 10 cases (66.66%) and poor in 5 cases (33.33%) whereas in headless group outcome was good in 13 cases (86.66%) and poor in 2 (13.33%) Conclusionfixation of Hoffa fracture with headless compression screw in comparison to CC screw (Headed Screw) have no significant difference in terms of functional outcome like range of motion but complications and implant failure is significantly higher in cases fixed with CC screw than in headless screw. So we conclude that overall outcome is better in study group fixed with headless compression screw as compared to cases fixed with CC Screw.

A Comparative Study of Operative Management of Internal Fixation of Closed Tibial Plateau Fracture by Plates with Screws and only Cannulated Cancellous Screws

A Comparative Study of Operative Management of Internal Fixation of Closed Tibial Plateau Fracture by Plates with Screws and only Cannulated Cancellous Screws

Unstable Fracture Neck of Femur in Young Adults: Management with Cannulated Cancellous Screws Augmented with Medial Buttress Plate

ABSTRACT Objective This study is to evaluate the clinical and radiological outcome of unstable fracture neck of the femur in young adults treated with three cannulated cancellous screws augmented with medial buttress plate. Materials and methods Fifteen patients of less than 60 years were operated from January 2017 to March 2018. Reduction was achieved by closed or open means to Garden's alignment index grade I. Internal fixation was done with three cannulated cancellous screws through mini lateral incision, and medial buttress plating was done through modified Smith–Peterson approach. All patients were mobilized from the immediate postoperative period and allowed toe-touch weight-bearing as tolerated. All patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Results Fracture united in 14 of 15 patients. Reduction loss and backing out of cancellous screws occurred in one patient. No cases of avascular necrosis was identified at a mean follow-up of 13.7 months. No significant femoral neck shortening was observed in all united fractures. Conclusion Anatomical reduction by closed or open method; stable fixation with three cannulated cancellous screws augmented with medial buttress plate, increases fracture union rate compared to the historical series using closed reduction and cancellous screw fixation alone. Open reduction and medial antiglide plate fixation do not appear to increase morbidity. How to cite this article Singaravadivelu V, Kartheesan G, Vignesh S. Unstable Fracture Neck of Femur in Young Adults: Management with Cannulated Cancellous Screws Augmented with Medial Buttress Plate. J Orth Joint Surg 2019;1(1):1–4.

Cannulated Screws and Braided Polyester Tension Band as an Alternative for Fixation of Transverse Patella Fracture: A Finite Element Analysis Study

BACKGROUND: Modified tension band wiring is a common surgical technique forfixation of patella fractures; however, various complications have been associated withmetal implants in this configuration. Modification of techniques and non-metallicimplants have been proposed in order to reduce hardware associated complications whileoptimizing fixation strength. Our study investigated the biomechanical strengthprovided by various modifications of figure-of-eight tension band constructs.MATERIALS AND METHODS: A finite element (FE) model of normal patella wasreconstructed based on CT images of a 46-year old man. Mathematical variations fromconversion of actual DICOM images into 3D geometric mesh were recorded. Simpletransverse fracture at the midpole was established with a 0.5 mm fracture gap. Twointerfragmentary fixations were made by using: 1) 2.0 mm K-Wires or 2) 4.0 mm. cannulatedcancellous screws. Figure-of-eight loop with 1.25 mm stainless-steel wire or FiberWireno.5 were allocated to each group. Figure of-eight loops in the K-wire group were invertical orientation while figure-of-eight loops in the cannulated screw group were inhorizontal orientation. These combinations constituted four different FE models. Analysiswas done on each model under the same environment, which was a 400N load on eachfragment at 45o flexion. Implant stress/strain and material deformation were determined.RESULTS: The models with cannulated screws have von Mises stress on implant thatis three times less than those with K-wires. The least von Mises stress occurred on thecombined cannulated screws and horizontal FiberWire loop model (471.2 MPa). Thiscombination also provided least deformation to loading condition (0.1267 mm).Traditional construct with K-wires and metal wire loop was found to have maximalstress (1422.9 MPa) and maximal deformation (0.3856 mm).CONCLUSION: Cannulated screws combined with FiberWire figure-of-eight loopoffers favorably low implant stress. Our findings demonstrate superior stability andresistance to implant failure of the construct. This low-profile tension band fixation couldbe a good alternative for transverse patella fracture.

The outcome of intracapsular hip fracture fixation using the Targon Femoral Neck (TFN) locking plate system or cannulated cancellous screws: A comparative study involving 2004 patients

AimThis study compares the outcome of intracapsular hip fracture fixation using the Targon Femoral Neck (TFN) locking plate system with the standard fixation using cannulated cancellous screws (CCS). Patients and methodAnalyses of a prospectively collected data of all patients treated for intracapsular hip fractures using the TFN system and CCS at our department over a period of 28 years. Baseline characteristics and specific outcome measures where compared. The primary outcome measure was fracture revision during the 1st year. Secondary outcome measures were fracture complications, any revision surgery, mortality and mobility status at one year after surgery. ResultsA total of 2004 fractures were included, a third (n=725, 36.2%) were treated using the TFN system. There were higher rates of non-union (19.5% vs 9.5%) and revision surgery (19% vs 9%) during the first year in the CCS cohort. Revision surgery was also higher in the same group during the whole of the follow-up period (22.2% vs 14.9%). The first year’s mortality rate was higher in the CCS cohort (21.1% vs 17.5%) but the reduction in mobility and mobility scores was the same in both cohorts. ConclusionThis study includes the largest cohort of cases treated for intracapsular hip fractures using the TFN system. It demonstrated that the TFN system was associated with lower rates of non-union, revisions and re-operations for any cause.

Functional Outcome of Isolated Hoffa Fractures Treated with Cannulated Cancellous Screw.

Introduction: Isolated Hoffa fracture is an infrequent injury and little research has been done on this subject. The purpose of this study was to evaluate the functional outcome and complications of surgically managed Hoffa fractures with cannulated cancellous screw.Materials and Methods: Between 2011 and 2014, eight isolated Hoffa fractures in seven adult patients with mean age 39.8±11.9 years (range 25-60 years) were managed with cannulated cancellous screw of 6.5mm diameter applied in anterior to posterior direction using swashbuckler and medial parapatellar approach for lateral and medial Hoffa fractures respectively. All patients were evaluated using knee evaluation score after two years or longer. Mean follow up was 28±3.8 months (range 24-36 months).Results: All fractures in the eight patients healed clinicoradiologically by the 16th week with excellent result in 87.5% cases and good in 12.5% cases. By the end of union, the range of motion (ROM) of the knee was 0° to 110° except in two patients. One patient had ROM 10°-100° and other had 15°-90°. Mean knee evaluation score was 87.5±10.4. There was no incidence of non-union, infection or avascular changes in the patients or loss of reduction till final follow up.Conclusion: Open reduction and fixation with two 6.5 mm cannulated cancellous screws with early mobilization yielded good functional outcome in isolated Hoffa fractures.

Pott’s fracture - Study of functional outcomes of various surgical treatments

Background: Pott’s fractures are very common in ankle injuries because of increased incidence of road traffic accidents and industrial trauma. Anatomical reduction and stable fixation is important for a painless ankle joint. Aim & Objectives: To study functional outcomes of various surgical treatments of pot’s fracture; to achieve stable fixation and early mobilization of the ankle. Materials and Methods: We have evaluated clinical, radiological and functional outcomes of 30 patients treated with different treatment modalities, which include - tension band wiring (TBW), Kirschner (K)-wire, malleolar screw (MS) and cannulated cancellous screws (CCS) for medial malleolus fracture and rush nail, one-third tubular plate, fibular locking plate for lateral malleolus fracture. Results: In this prospective study, 30 cases of Pott’s fractures of ankle were treated by different surgical method. Most common mode of injury was pronation and external rotation injury accounts for 53.34%. 29 cases were treated with open reduction internal fixation and one case associated with plafond fracture treated with external fixator. 15cases of medial malleoli fracture treated with TBW and 14 cases with malleolar / cannulated cancellous screw. Lateral malleoli fractures were treated with rush nail/ fibular plate. We found excellent results in 17 cases, good results in 8 cases, fair results in 4 cases and poor result in 1 case. Conclusion: In this study, after analysing our result, clinical and radiological results has been compared with other published result and found that TBW and fibular plate give excellent results. Level 1 evidence: Prospective study

Cannulated Cancellous Screw and Ender’s Nail Fixation in Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Cannulated Cancellous Screw and Ender’s Nail Fixation in Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition

Comparison of the functional outcome of DHS versus cannulated cancellous screws in pauwels type II and III fracture neck femur in young adults

Fracture neck of femur remains the unsolved fracture even in modern orthopaedics. It is an enigma to orthopaedic surgeons and curse for an individual with complications like avascular necrosis and nonunion. No clear difference exists with regards to the clinical results of patients treated with Cannulated screws or Dynamic hip screw fixation. 43 patients with fracture neck of femur were treated with either multiple cannulated cancellous screws (CCS) or dynamic hip screw (DHS) at Department of Orthopaedics, Hamidia hospital, Bhopal. Patients were called for follow up radiologically and clinical examination post operatively. Functional results were calculated with Modified Merle d’aubigne and postel method. Statistical analysis was done using p value.Fracture type, anatomical reduction and proper implant selection are the most important factor affecting the outcome of management of fracture neck femur. Patients treated with DHS had better Modified Merle d’aubigne score and earlier union. Average blood loss and mean operating time was higher in patients fixed with DHS. Dynamic Hip Screw (DHS) is a better implant in management of fracture neck femur in young adults in pauwels type II and III but complication rate does not depend on implant selection.

Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults

PurposeBoth cannulated cancellous screw (CCS) and sliding hip screw (SHS) are used in femoral neck fracture fixations, but which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. MethodsAdults (16–60 years) with femoral neck fracture were divided into Group 1 fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. ResultsGroup 1 (n = 40) achieved radiological union at mean of 7.6 months, with the union rate of 87.5% (n = 35), avascular necrosis (AVN) rate of 7.5% (n = 3) and mean Harris Hip Score (HHS) of 86.15 at the end of 4 years. In Group 2 (n = 45) these parameters were union at 7.1 months, union rate of 82.22% (n = 37), AVN rate of 6.67% (n = 3) and HHS of 88.65. Comparative results were statistically insignificant. ConclusionThere is no significant difference in clinicoradiological outcome between the two implants.

Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire

Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation.

Outcome analysis of post reduction pauwels angle in fracture neck of femur treated with dynamic hip screw or 6.5 mm cancellous cannulated screw fixation

Introduction: Fracture within the neck region of intracapsular area of hip known as fracture neck of femur. Radiologically breakage in shenton’s line is diagnosed as a fracture of neck of femur. Still this fracture remains an enigma to the Orthopaedic surgeon and is called as unsolved fracture. Aim of study: This study is undertaken to assess the correlation between post reduction Pauwel’s angle and union rate in the fracture neck of femur treated with either Dynamic Hip Screw or Cannulated Cancellous Screw fixation. Materials and Methods: This was a prospective study from June 2006 to October 2008. The study included 48 patients who underwent Dynamic Hip Screw and Cannulated Cancellous Screw fixation for fracture neck of femur. Results: This study evaluated Post reduction Pauwel’s angle for both types of fixation. Data analysis showed that with rise in Post reduction Pauwel’s angle, union rate decreases in both types of fixation. Conclusion: Post reduction Pauwel’s angle is a good guide to know the stability of fractures and decrease in this angle corrects shearing instability of the fracture site. This study gives an indication that with a vertical fracture line, a valgus osteotomy might help in decreasing the incidence of non union.