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A Useful Technique for the Removal of Cannulated Screws Lost due to Bony Ingrowth

Torrie, P. A. G. MD; Jones, C. B. MD

doi: 10.1097/BTO.0b013e31824be951
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Cannulated screw removal is often complicated by bony ingrowth. The screw head is typically not readily identifiable and difficult to locate making a simple procedure significantly more complex. The authors present a simple technique to aid surgeons readily locate cannulated screws lost due to bony ingrowth.

Department of Trauma and Orthopaedic Surgery, Royal United Hospital, Bath, UK

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to P. A. G. Torrie, MD, Department of Trauma and Orthopaedic Surgery, Royal United Hospital, Bath BA1 3NG, UK. E-mail: alextorrie99@hotmail.com.

Removal of metalwork is often not as simplistic as the title operation may suggest. The authors describe a useful technique to aid the removal of cannulated screws, using a 19 G spinal needle to pass through bony ingrowth and act as a screw head locator.

Modern fluoroscopy has enabled orthopedic surgeons to percutaneously fix numerous fractures, notably tibial plateau fractures, which previously would have necessitated open reduction before fixation (Fig. 1). Cannulated screws inserted into bone, particularly without the addition of a washer, have a tendency to lie deep to the cortex and may ultimately prove challenging to locate and subsequently remove, secondary to the bony ingrowth. Currently, excessive bony destruction or further fluoroscopic imaging is necessary at the time of removal to locate the true screw head position.

FIGURE 1

FIGURE 1

Where the tip of the cannulated screw is proud of the contralateral cortex, and subcutaneously palpable, it is readily possible to insert a spinal needle into the distal end of the screw, then using an AO small fragment hammer the spinal needle tip is judiciously advanced through the ipsilateral cortex (through the bony ingrowth) thus acting as a direct visual aid, on the original screw insertion cortex, to locating the true screw head position (Fig. 2). This aids the operating surgeon in identifying where the appropriate bony ingrowth must be removed and ultimately the cannulated screw head is situated. This technique avoids excessive bony destruction and aids the timely removal of cannulated screws lost secondary to bony ingrowth.

FIGURE 2

FIGURE 2

Keywords:

bony ingrowth; cannulated screw; removal

© 2012 Lippincott Williams & Wilkins, Inc.