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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

Twelve-year-old male with bilateral Blount disease, underwent bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis with a TBP. a Long erect X-ray shows preoperative bilateral varus deformity with medial mechanical axis deviation, b 3 months after insertion of bilateral distal femur and proximal tibia lateral physeal TBP, c last follow-up with corrected deformity and central mechanical axis. The broken left tibial metaphyseal screw occurred 2 years earlier, when the first TBP was inserted for gradual varus correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
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Fig3: Twelve-year-old male with bilateral Blount disease, underwent bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis with a TBP. a Long erect X-ray shows preoperative bilateral varus deformity with medial mechanical axis deviation, b 3 months after insertion of bilateral distal femur and proximal tibia lateral physeal TBP, c last follow-up with corrected deformity and central mechanical axis. The broken left tibial metaphyseal screw occurred 2 years earlier, when the first TBP was inserted for gradual varus correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

Mentions: Solid screws have been used with TBPs since 2008 in five patients, including four with Blount disease and one with bilateral genu varum. The five patients (two male, three female) had a mean age at surgery of 12.1 years (range 7.2−14.6 years). Figure 3 demonstrates a 12-year-old male with bilateral Blount disease who had bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis. A TBP was inserted using two solid screws using the same insertion technique.Fig. 3


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

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

Twelve-year-old male with bilateral Blount disease, underwent bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis with a TBP. a Long erect X-ray shows preoperative bilateral varus deformity with medial mechanical axis deviation, b 3 months after insertion of bilateral distal femur and proximal tibia lateral physeal TBP, c last follow-up with corrected deformity and central mechanical axis. The broken left tibial metaphyseal screw occurred 2 years earlier, when the first TBP was inserted for gradual varus 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

Fig3: Twelve-year-old male with bilateral Blount disease, underwent bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis with a TBP. a Long erect X-ray shows preoperative bilateral varus deformity with medial mechanical axis deviation, b 3 months after insertion of bilateral distal femur and proximal tibia lateral physeal TBP, c last follow-up with corrected deformity and central mechanical axis. The broken left tibial metaphyseal screw occurred 2 years earlier, when the first TBP was inserted for gradual varus correction.Copyright 2016, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore
Mentions: Solid screws have been used with TBPs since 2008 in five patients, including four with Blount disease and one with bilateral genu varum. The five patients (two male, three female) had a mean age at surgery of 12.1 years (range 7.2−14.6 years). Figure 3 demonstrates a 12-year-old male with bilateral Blount disease who had bilateral distal femoral and proximal tibial lateral hemiepiphysiodsis. A TBP was inserted using two solid screws using the same insertion technique.Fig. 3

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