Single Compression Screw Research Articles

Functional outcome of intertrochanteric fracture fixed with proximal femoral nail anti-rotation (PFNA2)

Introduction: Intertrochanteric fractures are the most common geriatric fractures associated with osteoporosis requiring surgical intervention. For fixation of these fractures, use an intramedullary nail coupled with a dynamic femoral head/neck stabilisation implant. Many classes of nails incorporating a single compression screw, an extramedullary device, or a compression screw coupled with an anti-rotation screw like the proximal femoral nail have become famous for treating unstable fractures. In this study, we studied the outcome of PFNA2 fixation devices. Material and Methods: This is a prospective cohort study of unstable IT fragility fracture of femur treated with PFN A2. All successive patients are diagnosed with unstable intertrochanteric Boyd and Griffin type 2, 3 and 4 fractures of the femur. Results: We found that the average RUSH score at the end of 6 months was 23.8, and the functional outcomes were assessed with HHS with excellent functional outcomes in 20 cases, good in 3 and fair in 2. Complications were varus angulation and infection, one each. Conclusion: PFN A2 has a good functional outcome at the end of 1 year.

Subtalar arthrodesis using a single compression screw: a comparison of results between anterograde and retrograde screwing.

The primary objective of this study was to compare the radiological and clinical results of anterograde and retrograde screwing in subtalar arthrodesis using a single compression screw. The secondary objective was to evaluate the subjective results and consolidation of this procedure. The hypotheses were that isolated screw fixation was sufficient to achieve good consolidation and that there was no difference between the two techniques with a similar rate of bone fusion. This is a monocentric, retrospective, radio-clinical study based on 99 patients (101 feet), 58 males and 41 females, with an average age of 64years. The main aetiology was post-traumatic osteoarthritis, which represented 51% of cases. Two groups were formed: group A (52 feet) consisting of fixed arthrodesis with ascending (retrograde) screwing and group D (49 feet) consisting of fixed arthrodesis with descending (anterograde) screwing. The two groups were statistically comparable in terms of demographic data as well as aetiologies and comorbidities. Arthrodeses which were not fused at 6months were reassessed at one year and in the event of any radio-clinical doubt regarding consolidation, an additional CT scan was prescribed. Average post-operative follow-up was 11 ± 5years (2-27years). Ninety-two arthrodeses (93%) were fused at one year and 9 were considered to be in non-union, 5 (9.8%) in group A, and 4 (8.3%) in group D. We recorded 30 complications, 22 of which were due to a conflict with the screw head, 18 (34.5%) in group A and 4 (8.3%) in group D (p = 0.03). Conflict between the screw head and the heel led to the removal of the screw after consolidation of the arthrodesis. The clinical results were evaluated using Odom's criteria. Nine per cent of patients described their results as excellent, 29% as good, 51% as satisfactory and 11% found the result to be poor. The fusion rate for isolated compression screw arthrodesis is good, and there is no difference between anterograde and retrograde screws. However, the discomfort caused by the screw head being insufficiently embedded in the retrograde group led to a non-negligible number of additional surgeries to remove the screw.

Arthrodesis of the First Metatarsophalangeal Joint Using a Single Screw: Retrospective Analysis of 109 Feet

Arthrodesis of the first metatarsophalangeal joint is a recommended technique for hallux rigidus. The preparation of the joint surfaces and the way in which fixation is achieved might be relevant in success or failure of the arthrodesis. All patients were selected from archived records of operations performed at the 'Groene Hart' Hospital in Gouda, the Netherlands, from 1996 until 2005. Patients were operated following a fixed protocol using flat surfaces and a single compression screw bridging the arthrodesis from proximal medial to distal lateral. Their charts were reviewed retrospectively. Answers to questions regarding their current pain, shoe wear, and walking ability were recorded using the criteria of the AOFAS foot score as a template in a questionnaire. Of a total of 109 arthrodesis, 104 (95.4 %) united within 8 weeks without problems. Four feet were re-operated for pseudoarthrosis and one was re-operated for malunion with too much dorsiflexion. Removal of the intramedullary screw was necessary in 85 feet (78%). Of the 79 patients who returned their questionnaire, 58 patients (73.4%) considered their problems solved and 57 patients (72%) were completely satisfied with the result. Our study shows that a single screw fixation method is an effective technique in treating hallux rigidus, with high satisfaction in patients between 40 and 80 years of age. 4.

Symptomatic Nonunion of a Distal Phalanx Fracture: Treatment With a Percutaneous Compression Screw

Fractures of the distal phalanx caused by crush injuries occur frequently but rarely result in nonunions. This article describes 2 patients with a symptomatic hypertrophic nonunion after a fracture of the waist of the distal phalanx of the thumb. Following the general principles of nonunion treatment, both patients were successfully treated with a single compression screw inserted by a minimally invasive approach.

P.268 The bone formation between segments after SSRO

The mechanical strengths of five common fixation techniques for spiral fractures have been tested. A total of 240 cadaver metacarpals and proximal phalanges were fractured and fixed by either crossed K-wires, interosseous loops, a dorsal mini-plate, a single compression screw or K-wire plus cerclage wire. Specimens were subjected to torsional and cantilever bending tests. A single compression screw provided the best overall fixation for the proximal phalanx. In addition, a single compression screw provided better fixation than any of the other techniques when proximal phalanges and metacarpals were subjected to torsional tests (P < 0.05). In apex dorsal bending tests of metacarpals, the screw provided fixation superior to interosseous wires, crossed K-wires, or dorsal mini-plates (P < 0.05). These results indicate that the use of a single compression screw provides the most satisfactory biomechanical advantage for spiral fracture fixation.

In Vivo Comparison of Screw versus Plate and Screw Fixation for First Metatarsophalangeal Arthrodesis: Does Augmentation of Internal Compression Screw Fixation Using a Semi-Tubular Plate Shorten Time to Clinical and Radiologic Fusion of the First Metatarsophalangeal Joint (MTPJ)?

A retrospective analysis of first metatarsophalangeal joint fusion in 26 consecutive patients (34 feet), treated between April 1998 and February 2002, comparing single compression screw versus a compression screw supplemented with a dorsal quarter tubular plate, was undertaken. The study aimed to assess whether or not plate augmentation of the single interfragmental compression screw lead to an earlier fusion. There were 18 women and 8 men with a mean age of 54.6 +/- 11.02 years and a mean follow-up of 2.9 +/- 1.1 years. Successful fusion was determined clinically and radiologically by means of identifying transarticular trabeculation. The overall incidence of fusion was 97.06% (33/34 fusions). Observed complications included 4 cases of superficial wound infection, each of which resolved with antibiotic therapy; 3 cases of paraesthesia involving the dorsomedial aspect of the big toe; and 2 cases of transfer metatarsalgia. Statistical analyses did not reveal any significant associations between the type of fixation and time to fusion, patient satisfaction, and complications. In regard to the methods of osteosynthesis compared in this investigation, the choice of first metatarsophalangeal fusion fixation can be determined based on surgeon's preference. ACFAS Level of Clinical Evidence: 2c.

Subtalar arthrodesis with internal compression for post-traumatic arthritis.

We studied retrospectively the results in 24 patients (25 feet) who had been treated by subtalar arthrodesis with internal compression for post-traumatic arthritis from 1988 to 1992. Fifteen patients were men (16 feet) and nine (9 feet) were women. Their mean age was 43 years (22 to 68), and the average duration of follow-up was four years (2 to 6). A single compression screw was used in all feet and iliac-crest bone grafting in ten. Union was achieved in 24 of the 25 feet (96%). Based on a clinical scale the results were excellent in 10 feet, good in 7, fair in 6, and poor in 2 and on the Angus and Cowell score they were good in 19 feet, fair in 4, and poor in 2. The two poor results were due to nonunion in one patient and reflex sympathetic dystrophy in the other. One reoperation was performed for nonunion. Eighteen patients (18 feet) were satisfied with the results, four were satisfied with reservations, and three were dissatisfied. Progressive ankle and midfoot arthritis did not occur in the absence of pre-existing degenerative changes in these joints. We conclude that isolated subtalar arthrodesis with internal compression was effective treatment for post-traumatic subtalar arthritis. Iliac-crest bone grafting was not routinely required.

Subtalar arthrodesis with internal compression for post-traumatic arthritis

We studied retrospectively the results in 24 patients (25 feet) who had been treated by subtalar arthrodesis with internal compression for post-traumatic arthritis from 1988 to 1992. Fifteen patients were men (16 feet) and nine (9 feet) were women. Their mean age was 43 years (22 to 68), and the average duration of follow-up was four years (2 to 6). A single compression screw was used in all feet and iliac-crest bone grafting in ten. Union was achieved in 24 of the 25 feet (96%). Based on a clinical scale the results were excellent in 10 feet, good in 7, fair in 6, and poor in 2 and on the Angus and Cowell score they were good in 19 feet, fair in 4, and poor in 2. The two poor results were due to nonunion in one patient and reflex sympathetic dystrophy in the other. One reoperation was performed for nonunion. Eighteen patients (18 feet) were satisfied with the results, four were satisfied with reservations, and three were dissatisfied. Progressive ankle and midfoot arthritis did not occur in the absence of pre-existing degenerative changes in these joints. We conclude that isolated subtalar arthrodesis with internal compression was effective treatment for post-traumatic subtalar arthritis. Iliac-crest bone grafting was not routinely required.

Spiral fracture fixation techniques A biomechanical study

The mechanical strengths of five common fixation techniques for spiral fractures have been tested. A total of 240 cadaver metacarpals and proximal phalanges were fractured and fixed by either crossed K-wires, interosseous loops, a dorsal mini-plate, a single compression screw or K-wire plus cerclage wire. Specimens were subjected to torsional and cantilever bending tests. A single compression screw provided the best overall fixation for the proximal phalanx. In addition, a single compression screw provided better fixation than any of the other techniques when proximal phalanges and metacarpals were subjected to torsional tests ( P < 0.05). In apex dorsal bending tests of metacarpals, the screw provided fixation superior to interosseous wires, crossed K-wires, or dorsal mini-plates ( P < 0.05). These results indicate that the use of a single compression screw provides the most satisfactory biomechanical advantage for spiral fracture fixation.