Kongkhet Riansuwan

Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal.

A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.

Removal of a Broken Cannulated Femoral Nail: A Novel Retrograde Impaction Technique

This report presents a surgical technique to remove a broken cannulated nail from the femur. A Harrington rod was modified for retrograde impaction of the retained fragment. The broken implant was finally removed without complication. This particular procedure was safe, simple, and promising.

Delay Fixation of Trochanteric Fractures Using Dynamic Hip Screw: A Minimally Invasive Technique

Summary: Fixation using dynamic hip screw (DHS) is well accepted as a treatment method for stable type trochanteric fractures. In delayed fixation cases, the conventional technique for DHS fixation with large exposure may disturb fracture callus and retard fracture healing. To minimize the disturbance of the fracture area, a minimally invasive method of DHS insertion has been developed. The method includes the insertion of lag screw guide-wire by free hand technique. Tapping and lag screw insertion is performed as in the conventional technique. The position of the T-handle is rotated 90 degrees clockwise before removal. The barrel is inserted with the side-plate in 90 degrees upward direction until the side-plate reaches the cortex. The side-plate is gradually rotated counter-clockwise until it is parallel to the femoral shaft. The screw insertion to fix the side-plate to the femoral shaft is performed using fluoroscopic assisted technique. This method was successfully applied in 15 patients whose ages ranged from 67–86 years with an average of 78 years. The mean operation time was 37 minutes (range, 30–50) with average fluoroscopic time of 45 seconds (range, 30–80). Blood loss averaged 40 ml (range, 30–70). The mean length of skin incision was 3.5 cm (range, 3–5). The proposed method had minimal blood loss, short skin incision, and was performed without open manipulation at the fracture zone. There was no intra-operative complication. Fourteen cases were followed up until fractures healed with average fracture healing time of 14 weeks (range; 10–18) after surgery.

Capture of the screw during percutaneous screw insertion

The simple technique to maintain the engagement of the screw and the screw driver during percutaneous locking screw insertion is presented. The method can capture the screw when the screw becomes disengaged. This will be helpful when percutaneous screw insertion is performed in the narrow and deep location of the bone such as a locking screw at the upper part of the femur during retrograde femoral nailing.