AO Foundation Education Design and function of surgical screws Steve R Schelkun, Coronado, USA AOTrauma Principles CourseLearning outcomes * Identify what is a screw * Define the design characteristics of a screw * List what kind of screws are available * Explain how a screw works * Describe how the lag screw technique provides absolute stability * State the purpose of the countersink * Evaluate the different functions of screwsWhat is a screw? A simple mechanical device for turning rotational forces into linear motion. . =) iG a z z 5 z co eae =Types of screws and material cortex screw cancellous bone screw stainless steel titanium “Aditi +] standard self-tapping me 6 yCortex screw terminology 4.5 mm cortex screw * 4.5 mm thread diameter * 8.0 mm head - Hexagonal - Cruciate - Star (Torx) * 1.25 mm pitch * 3.1 mm core diameter * 3.2 mm pilot drill bit * 4.5 mm gliding holeCortex screws 4.5 mm cortex screw thread is designed for application in diaphyseal bone.Cancellous bone screw terminology 6.5 mm cancellous bone screw * 6.5mm thread diameter * Thread length - Full - Partial, 32 mm or 16 mm * 8.0mm head * 1.75 mm pitch + 4.5 mm shaft * 3.2 mm pilot drill bit lh lk yy ly ys, Aa 32mm = 16 mmCancellous bone screws 6.5 mm cancellous bone screw is used in cancellous or spongy boneFunction of screws * Compression * Types of compression: - Plate to bone - Two bone fragments for interfragmentary compression Peay A. a ari ™ ean eal ~Working concept of screws * Threads advance screw * Head contacts bone (plate) * Compression under head * Tension in shaft * Friction produces stability - Under plate - Between fragments = zZ se Ss a ss ss aa a 10Principle of the lag screw technique * Itis a technique of insertion not a type of screw * Any screw can function as a lag screw * Provides interfragmentary compression * Produces 2500-3000 Newtons of force * Results in absolute stability 41Conditions—interfragmentary compression * Screw must glide through near cortex * Threads hold only in far cortex * Screw head stops at near cortex \ + Best compression 90° a9Axiom Any time a screw crosses a fracture line it must be inserted as a lag screw to provide interfragmentary compression. aBone-screw interface + Maximum stress is between screw head and bone cortex * Countersink to maximize contact between screw and bone to minimize stress 14When to countersink * Cortical bone * Screw outside plate * Create circular “seat” for undersurface of screw head * Oblique orientation produces oval hole 15Washers + Metaphyseal bone * Thin cortex * Artificial cortex * Two sides - Flat and concave 16Lag screw technique—step 1 * Drill 4.5 mm gliding hole near cortex * Protect soft tissues, use 4.5 mm drill sleeve 417Lag screw technique—step 2 * Drill 3.2 mm threaded hole : in far cortex * i No * Insert drill sleeve i * Colinear e a a> ane gliding hole Erie m yi ea ited wor) Teaco) El) 18Lag screw technique—step 3 + Use 4.5 mm countersink * Create circular seat for undersurface of screw 19Lag screw technique—step 4 Use depth gauge to measure depth of hole + Longest distance allows maximum purchase correct length reading Pry reading too sot fp sdLag screw technique—step 5 Tap cortex with 4.5 mm tap * Screw and tap same size : Always use tap sleeve * Soft tissue protection * Direction and wobble Always its Gani Emre 21Lag screw technique—step 6 Insert 4.5 mm cortex screw * Interfragmentary compression * Absolute stability \ WER,Six step lag screw technique Using 4.5 mm cortex screw: * Drill 4.5 mm gliding hole * Drill 3.2 mm threaded hole * Countersink « Measure depth * Tap * Screw 22Names of the different screw functions + Lag/interfragmentary compression screw * Compression screw * Position screw * Locking head screw ¢ Buttress/antiglide screw + Anchor screw * Push-pull screw * Reduction screw * Poller screw 24Screw functions—lag screw Cancellous screws create interfragmentary compression. 25Screw functions—plate compression screwScrew functions—position screw + Syndesmosis * No compression OTlocking head screw Screw functions 28Screw functions—buttress/antiglide screw 29Screw functions—anchor screw 30Screw functions—push-pull screwScrew functions—reduction screwScrew functions—Poller screw/blocking screw 33Summary + Every screw has two names * Any screw can perform different functions * Lag screw is a technique - Building block of internal fixation - Interfragmentary compression - Absolute stability * Countersink to distribute forces under the screw head * Washer in metaphyseal regionshttp://www.aofoundation.org/www/elearning/modules/intro/index.html B ‘AO Foundation 0 Principies Surgical screw fixation ry _ F oS 35Next * Function of plates * Principles of stability * Practical exercise 1 - Application of these principles - Absolute stability 36