Effects of Removal and Reinsertion of Headless Compression Screws

PURPOSE

This study investigates the loss of compression when 3 commonly used headless compression screws are backed out (reversed), and assesses the ability to re-establish compression with screws of greater diameter.

METHODS

Two investigators tested 3 screw designs (Acutrak 2, Synthes HCS, Medartis SpeedTip CCS) in 2 diameters and lengths. Each design had 10 test cycles in a polyurethane foam bone model with compression recorded using a washer load cell. A 28-mm screw of the narrower diameter was inserted until 2 mm recessed and then reversed 30°, 60°, 90°, 180°, 270°, 360°, and 720°. After this the screw was removed completely and a 24-mm screw of greater diameter inserted until recessed 2 mm with the compressive force again recorded.

RESULTS

All screws showed an immediate, statistically significant loss of compression at 30° of reversing. The Acutrak 2 Micro screw demonstrated not only the greatest mean compressive force, but also the fastest compressive loss. Insertion of the shorter screw of greater diameter was associated with re-establishment of compression to levels comparable with the original screw.

CONCLUSIONS

This study reaffirms the importance of establishing the correct screw length before insertion due to the immediate loss of compression with reversal of these devices.

CLINICAL RELEVANCE

If a headless compression screw penetrates the far joint surface, the screw should be completely removed and replaced with a shorter screw of greater diameter.

Sir John Charnley (1911-1982): Inspiration to Future Generations of Orthopaedic Surgeons

For young doctors embarking on a career in medicine, the decision on which path to take is often influenced by their experiences as an undergraduate student and, in particular, by those doctors and teachers who have stimulated and encouraged them. Likewise, inspiration can be derived from studying the life and work of eminent practitioners of the past. A final year elective module provided me with the opportunity to undertake a detailed critique of an aspect of the history of medicine of my choosing, which enabled me to investigate the history of hip replacement. This opened my eyes to the prodigious contribution of Sir John Charnley in the field of orthopaedics. His commitment to the practice and advancement of medical science is indeed an inspiration. This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.

Patella osteotomy: a new approach for complex trauma around the knee

Complex floating knee injuries, comprising complete articular distal femur and proximal tibia fractures, are a significant challenge in Orthopedic Traumatology. Traditional surgical approaches can result in a limited exposure, compromising osteosynthesis, with an extensive soft tissue dissection predisposing to adhesion of the quadriceps and arthrofibrosis. The Patella Osteotomy technique provides unrivaled visualization of the articular surfaces of the knee, with a limited soft tissue dissection to permit the anatomical reconstruction of the articular injury, while minimizing the risk of postsurgical complications and reducing intraoperative fluoroscopy time.

Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results

BACKGROUND

This report documents our experiences with a new technique for reconstructing massive uncontained defects of the glenoid with reverse total shoulder arthroplasty.

MATERIALS AND METHODS

We use a modified deltopectoral approach to perform the combined allograft-autograft construct glenoid reconstruction. We make use of a peripherally seated cortical allograft acting as a sleeve bushing to provide a stable ring under compression in which to house impacted cancellous autograft centrally for early incorporation and in-growth with the long-peg Aequalis (Tornier, Saint-Ismier Cedex, France) reverse total shoulder arthroplasty baseplate.

RESULTS

Our case series now comprises 10 patients with postoperative follow-up of up to 36 months. We report the first 5 patients here, all of whom have more than 12 months of follow-up. Computed tomography scanning demonstrates incorporation of the graft as early as 6 months. None of these patients have had loosening, implant failures, dislocations, periprosthetic fractures, or infections. One patient sustained an acromial stress fracture that was successfully treated nonoperatively, and 1 patient has nonprogressive grade I notching.

CONCLUSION

The hybrid graft glenoid reconstruction is a useful and versatile technique in the setting of massive uncontained defects of the glenoid and permits the implantation of a reverse total shoulder arthroplasty. We believe this technique is reproducible and uses materials that are both readily available and familiar.

Sir John Charnley (1911-1982): inspiration to future generations of orthopaedic surgeons

For young doctors embarking on a career in medicine, the decision on which path to take is often influenced by their experiences as an undergraduate student and, in particular, by those doctors and teachers who have stimulated and encouraged them. Likewise, inspiration can be derived from studying the life and work of eminent practitioners of the past. A final year elective module provided me with the opportunity to undertake a detailed critique of an aspect of the history of medicine of my choosing, which enabled me to investigate the history of hip replacement. This opened my eyes to the prodigious contribution of Sir John Charnley in the field of orthopaedics. His commitment to the practice and advancement of medical science is indeed an inspiration. This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.

An examination of the role of clinical psychology in meeting the needs of young disabled clients and their families/carers

This paper examines the views of clients with a physical disability, general practitioners and staff working in health and social work physical disability services about the needs of young disabled people. The most common area of disability seen by GPs was respiratory, followed by cardiac problems and stroke. With the exception of cardiac patients a third to over half of GPs felt that the needs of the identified groups were not being adequately met, in particular the needs of individuals with progressive neuromuscular problems. Over a quarter of clients felt that their needs were not being adequately met. Ninety-five percent of GPs and 100% of staff identified psychological needs of clients. For clients themselves, physical needs are ranked highest, with over 33 percent identifying psychological problems, 50 percent neuropsychological problems and 25 percent psychosexual difficulties as priority needs. In relation to carers, over 90 percent of GPs, 100% of staff and 50 percent of clients highlighted psychological needs. The majority of participants felt that clinical psychology had an important role to play in physical disability services. There was broad agreement on the areas of need which psychology would be seen to address. These were psychological needs, behavioural problems, neuropsychological problems and relationship/psychosexual difficulties. A high percentage of both staff and GPs also saw a role for clinical psychology in meeting the psychological, relationship and psychosexual needs of carers.