slipped screw

[pratul]

Respected doctors
28 years male with radius platting came to us to remove implant after
7 years of his operation. I was unable to remove the screw as it
slipped with the screwdriver. I didn’t find any way to remove it.
Looking forward for valuable suggestions-

[David Nelson]

You need to give us xrays. What brand of device? Titanium? What stripped,
the driver or the head? What location, distal screws or shaft screws?

David Nelson

----- Original Message -----
From: "pratul" <prat...@gmail.com>
To: "Orthopod" <orth...@googlegroups.com>
Sent: Thursday, December 17, 2009 8:13 AM
Subject: [Orthopod] slipped screw

Respected doctors
28 years male with radius platting came to us to remove implant after
7 years of his operation. I was unable to remove the screw as it

slipped with the screwdriver. I didn�t find any way to remove it.

Looking forward for valuable suggestions-

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[Hanume Gowda]

Dear Dr Praful,

I understand that the screw head slot has got rounded off and the screw driver slips in the slot or does not snugly fit in.

There are special devices for thiese situations. I have used a system from JJ Surgicals ( India ) it works well

dr hanumegowda

Bengaluru

[george therthanath]

Dear Praful,

 

Synthez has a broken screw removal instrumentation set. This was originally printed as a separate chapter in the catalogue. But the recent editions of catalogue has it listed under general instrumentation if I am not mistaken. This set has a conical screw for removing the screws where the slot of the head has become rounded. The screw directions are such that when you try to unwind the cortical screw, the conical screw bites into the damaged head of the screw. If the cortical screw is not badly incarcerated in the bone, it will come out. In the worst scenario, you may have to use some instruments to knock off the head f the screw or even cut the plate to remove the plate and then use hollow reamers provided in the set to remove the incarcerated screw.

 

In any delayed implant removal and also in the second attempt, it may be advisable to take informed consent that, the implants may not come out or there could be iatrogenic fractures during the procedure, or delayed fractures after the procedure and the bone may need to be protected for quite some time.

 

Best of luck.

 

Dr. T. I. George,

(Dr George T Ittoop),
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 400.
North Sharquia Region,
Sultanate of Oman.
Cell phone no: 968 95825197

[George Thomas]

Dear Praful,

The broken screw set from Synthes is excellent but expensive. I use the following technique: when 3.5 mm screws are to be removed, I carefully drill very near the difficult screw. This is possible only if the plate has DCP holes. One has to be very careful not to break the drill bit. This causes the screw to loosen. I have also heard that people use cautery next to the screw. This probably works by bone necrosis.

I endorse all that Dr. T.I. George has said. You can get into a lot of trouble removing implants. 

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--
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
Phone +91-44-24991081/82/83
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in

[Terri Zachos]

Dear Dr. Pratul:

 

I have used a screw extractor system made by Synthes. I liked it.

 

Sincerely,

 

Tiffy Zachos

 

______________________________________________________________
T.A. Zachos, DVM, PhD, Dipl, American College of Veterinary Surgeons
Assistant Professor of Orthopaedic Surgery
Department of Small Animal Clinical Sciences
Michigan State University
D-208 Veterinary Medical Center
East Lansing, MI 48824-1314
Phone: (517) 353-5420
Fax: (517) 355-5164

http://orthodoc.aaos.org/zachos

E-mail: zach...@cvm.msu.edu