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Solid screw insertion for tension band plates: a surgical technique tip.

Kadhim M, Hammouda AI, Herzenberg JE - J Child Orthop (2016)

Bottom Line: The downside of solid screws is the decrease in precision of placement.It is recommended to use solid screws with TBPs in patients with a high body mass index to avoid screw fracture.Our technique describes using a cannulated screw as a tap to create a tract to ease accurate insertion of the solid screws, and prevent the solid screw from deviating outside the desired path.

View Article: PubMed Central - PubMed

Affiliation: Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.

ABSTRACT

Purpose: Growth modulation with tension band plates (TBPs) and cannulated screws is the current mainstay of treatment for pediatric lower extremity angular deformities. Solid screws have been used as an alternative to cannulated screws to decrease the risk of screw failure, particularly in obese children. The downside of solid screws is the decrease in precision of placement. This study describes a surgical technique to insert solid TBP screws accurately.

Methods: TBP insertion starts with the same conventional steps by inserting the guidewires into the epiphysis and metaphysis, straddling the physis. After fluoroscopic confirmation of the position of the guidewires, the cannulated drill bit is used to broach the cortex to a depth of 5 mm in the bone. A standard 4.5-mm cannulated screw from the TBP set is used to tap the screw tract over the guidewires for approximately three-quarters of the planned screw length. After removing the guidewires, the solid screws are then inserted in each hole to follow the tapped tracts.

Results: This technique was used in five patients including four with Blount disease and one with bilateral genu varum.

Conclusion: It is recommended to use solid screws with TBPs in patients with a high body mass index to avoid screw fracture. Our technique describes using a cannulated screw as a tap to create a tract to ease accurate insertion of the solid screws, and prevent the solid screw from deviating outside the desired path.

No MeSH data available.


Related in: MedlinePlus

Intraoperative images demonstrating the surgical technique. a A central K-wire is inserted at the physis level, b a K-wire is inserted in each eccentric screw hole of the plate, c, d a 3.2-cannulated drill bit is used to broach the cortex at each screw hole, e a cannulated screw is used as a tap, f a solid screw is inserted into the distal hole, g a cannulated screw is used to tap the proximal hole, h, i follow-up films during correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
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Fig2: Intraoperative images demonstrating the surgical technique. a A central K-wire is inserted at the physis level, b a K-wire is inserted in each eccentric screw hole of the plate, c, d a 3.2-cannulated drill bit is used to broach the cortex at each screw hole, e a cannulated screw is used as a tap, f a solid screw is inserted into the distal hole, g a cannulated screw is used to tap the proximal hole, h, i follow-up films during correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

Mentions: A 4.5-mm cannulated screw is then used as a tapping tool over the guidewire to tap at least three-quarters of the desired screw length. The guidewire is then removed to insert a 4.5-solid screw that follows the path created by the tapping (Figs. 1, 2). Controversy exists regarding parallel or divergent position of the two screws.Fig. 1


Solid screw insertion for tension band plates: a surgical technique tip.

Kadhim M, Hammouda AI, Herzenberg JE - J Child Orthop (2016)

Intraoperative images demonstrating the surgical technique. a A central K-wire is inserted at the physis level, b a K-wire is inserted in each eccentric screw hole of the plate, c, d a 3.2-cannulated drill bit is used to broach the cortex at each screw hole, e a cannulated screw is used as a tap, f a solid screw is inserted into the distal hole, g a cannulated screw is used to tap the proximal hole, h, i follow-up films during correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940243&req=5

Fig2: Intraoperative images demonstrating the surgical technique. a A central K-wire is inserted at the physis level, b a K-wire is inserted in each eccentric screw hole of the plate, c, d a 3.2-cannulated drill bit is used to broach the cortex at each screw hole, e a cannulated screw is used as a tap, f a solid screw is inserted into the distal hole, g a cannulated screw is used to tap the proximal hole, h, i follow-up films during correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
Mentions: A 4.5-mm cannulated screw is then used as a tapping tool over the guidewire to tap at least three-quarters of the desired screw length. The guidewire is then removed to insert a 4.5-solid screw that follows the path created by the tapping (Figs. 1, 2). Controversy exists regarding parallel or divergent position of the two screws.Fig. 1

Bottom Line: The downside of solid screws is the decrease in precision of placement.It is recommended to use solid screws with TBPs in patients with a high body mass index to avoid screw fracture.Our technique describes using a cannulated screw as a tap to create a tract to ease accurate insertion of the solid screws, and prevent the solid screw from deviating outside the desired path.

View Article: PubMed Central - PubMed

Affiliation: Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.

ABSTRACT

Purpose: Growth modulation with tension band plates (TBPs) and cannulated screws is the current mainstay of treatment for pediatric lower extremity angular deformities. Solid screws have been used as an alternative to cannulated screws to decrease the risk of screw failure, particularly in obese children. The downside of solid screws is the decrease in precision of placement. This study describes a surgical technique to insert solid TBP screws accurately.

Methods: TBP insertion starts with the same conventional steps by inserting the guidewires into the epiphysis and metaphysis, straddling the physis. After fluoroscopic confirmation of the position of the guidewires, the cannulated drill bit is used to broach the cortex to a depth of 5 mm in the bone. A standard 4.5-mm cannulated screw from the TBP set is used to tap the screw tract over the guidewires for approximately three-quarters of the planned screw length. After removing the guidewires, the solid screws are then inserted in each hole to follow the tapped tracts.

Results: This technique was used in five patients including four with Blount disease and one with bilateral genu varum.

Conclusion: It is recommended to use solid screws with TBPs in patients with a high body mass index to avoid screw fracture. Our technique describes using a cannulated screw as a tap to create a tract to ease accurate insertion of the solid screws, and prevent the solid screw from deviating outside the desired path.

No MeSH data available.


Related in: MedlinePlus