In recent years, I have noted a shift towards headless screw usage in multiple foot and ankle applications. In my observation, headless screws boast a low-profile design with the ability to bury the screw below the bone’s cortical surface leading to decreased soft tissue adhesion and irritation. But, are we getting the best screw for those perks? than the measured depth. After selecting the size, advance the guide wire approximately 5 mm to maintain distal pin fixation before drilling. Besides aesthetics, another advantage of using grub screws (with no leading or trailing edge exposed at the head end) is that they can often offer better resistance to weathering and corrosion as a result. They can also be driven with considerably more torque force than traditional screws, as the uniform diameter right the way along the full length of the grub screw shaft means that they don’t begin to split the hole apart as they go in further. Instead, the the surrounding material into which the set or grub screw is driven will work to reinforce the fastening as it goes in.

van Zwienen CMA, van den Bosch EW, Snijders CJ, Kleinrensink GJ, van Vugt AB. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004;18(9):589–95. Routt MC Jr, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 11:584–589 Osterhoff G, Noser J, Sprengel K, Simmen H-P, Werner CM. Rate of intraoperative problems during sacroiliac screw removal: expect the unexpected. BMC Surg. 2019;19(1):1–6.

Plain Cup Point (PCP)

Although group CCS revealed comparable results to RSV, it was associated with higher stability regarding cycles to predefined failure criteria

cone point tip grub screws, which are ideal for exerting additional force when joining items made from softer materials, or to fit into an existing depression in the piece being mated toOverall, IMCS fixation is a reliable technique for the surgical management of transverse and short oblique metacarpal, proximal and middle phalangeal fractures. This intramedullary fixation is not advisable for long oblique fractures and the critical angle at which an oblique fracture becomes unsuitable for IMCS is still under debate. A double-screw construct is recommended for comminuted subcapital fractures of the metacarpal to avoid metacarpal shortening. IMCS can even be applied for peri-articular fractures of the proximal third of the phalanx and in some multi-fragmentary proximal and middle phalangeal fractures. Open access For the partially threaded screws in groups PT and CCH, a movement of the joint around the threadless smooth part of the screw shafts is conceivable and could therefore explain their higher stability during testing. Likewise, as seen in fixations of ankle fractures, partially threaded screw designs have been proven to decrease both initial screw stiffness and yield load, compared to fully threaded screws [ 35]. Generally, the mobility should be minimized after insertion of two screws. The higher interfragmentary stability of the fixations with partially treaded versus fully threaded screws, indicated by Gap Angle, was also evidenced by Total Displacement (at the most superior aspect of the fracture line), however, the latter evidence could not be substantiated statistically due to the fact that the differences between the groups became pronounced at a later stage of cyclic testing compared to Gap Angle. Chip MC Jr, Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996;10(3):171–7.

proximal portion if the wire were to break. A second de-rotation wire can then be inserted in those cases where it is felt that there is a possibility of rotational instability of the fracture. 5. DrillFrom a biomechanical perspective, S1-S2 SI joint fixation using two cannulated compression headless screws or two partially threaded SI screws exhibited better interfragmentary stability compared to two fully threaded SI screws. The former can therefore be considered as a valid alternative to standard SI screw fixation in posterior pelvis ring injuries. In addition, partially threaded screw fixation was associated with less bone-implant movements versus fully threaded screw fixation. Further human cadaveric biomechanical studies with larger sample size should be initiated to understand better the potential of cannulated compression headless screw fixation for the therapy of the injured posterior pelvis ring in young trauma patients.

The hypothetical target group for SI screw fixation with cannulated compression headless screws considers young patients with good bone quality. This study was able to show a partly superior and partly comparable stability of fixation with these screws versus conventional SI screws.

Knurled Cup Point (KCP)

Metal is a whole different story when compared to wood. If you have a screw that has a broken head inside of metal, removing it is going to be a bit of a challenge. However, with the right steps, it is possible. What makes it so difficult is that when you have a metal screw screwed into metal, rust can occur. When rust occurs, it’s literally going to bond the screw with the metal. Therefore, you need to find a way to deal with the rust. Ray R. Methods of Osseous Fixation. In: McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. (3rd ed.) Lippincott Williams & Wilkins;2001:65–106. The procedure can be carried out using the volar traction approach or using a conventional volar type approach with the arm supine on a hand table. The volar traction approach facilitates reduction of a displaced fracture and permits arthroscopy to ensure accuracy of the reduction. Select a screw the same size as measured. However, to account for countersinking and compression it is common to select a screw one size shorter