Synthes 2.4 3.0 Headless Compression Screw
Munir Junker
The titanium Compression FT (fully threaded) screws come in 2.5 mm Micro, 3.5 mm Mini, 4.0 mm Standard, 5.0 mm Large, and 7.0 mm XL. The variable-stepped thread pitch and headless design help reduce the risk of profile complications, provide compression, and allow for simplified insertion. Surgeons can now achieve zero-profile, stable fixation. The Compression FT family of screws now offers 5 diameters and 91 screw lengths to fit various orthopedic applications throughout the body.
Fixation of small and large bone fragments require meticulous reconstruction of the articular surface while preserving the surrounding cartilage and soft tissues. In order to achieve stable fixation with primary bone healing, the application of suitable controlled compression is preferred to support a high clinical success rate. Standard screws are problematic in intraarticular applications and in areas with little soft tissue coverage. Protruding heads may damage the joint surface or irritate soft tissue. Therefore, an adequately sized lag screw would be beneficial, one that could be buried below bone surface, for example, in the knee, ankle and foot.
The headless compression screw (HCS) 4.5 and 6.5 function the same way as the existing HCS 2.4 and 3.0. The design of the HCS 4.5 and 6.5 is specifically adapted to treat fractures, osteoarthritis or deformities of small to large bones. The HCS 4.5 is primarily intended for the calcaneus, talus, metatarsus, distal and proximal tibia, distal femur, as well as proximal humerus. The HCS 6.5 may be used for all the above except the proximal humerus.
For the large size HCS the same instrumentation as for the existing HCS can be used. The only additional ones are the attachment for compression sleeve for powered screw insertion, drill bit for predrilling the near cortex, and sleeve for compression sleeve.
Case 1: 62-year-old white female with right stage II posterior tibial tendon insufficiency and II and III overload due to medial cuneiform first metatarsal joint instability treated with UCBL for 6 months after she complained of severe pain and increasing swelling
A medial displacement osteotomy of the calcaneus and transfer of the tendon of the flexor digitorum longus to the navicular fixed with an interference screw were performed (see Fig 2a-c). A fusion of the first medial cuneiformmetatarsal I, II, and III modified. Weil osteotomy was performed as well.
A medializing calcaneal osteotomy was performed and fixed with two 6.5 mm HCS, a flexor hallucis longus transfer to her navicular is secured with an interference 7 mm screw and a lapidus procedure fixed with two crossing 4.5 HCS (see Fig 2a-b).
We use two 2.0-mm stainless steel headless compression screws for the fixation of acute scaphoid fractures, with the goal of more reliable and timely union because of increased biomechanical stability. For most acute scaphoid fractures without considerable deformity, we use a dorsal approach via a capsular incision made in line with the long axis of the scaphoid. The fracture is visualized, freshened, reduced, and held in place with the use of a pointed reduction clamp. The most technically demanding portion of the procedure is guidewire positioning to determine proper screw trajectory. The volar screw is position-limiting because of the dorsal rim of the distal radius. The wrist is hyperflexed, and the volar guidewire is inserted. The dorsal guidewire is placed approximately 3 mm dorsal and parallel to the volar guidewire. Ensure adequate bone stock is present in the proximal fragment to accept two threaded screw heads. The guidewires should be center-center in the coronal plane and just dorsal and volar to the central axis in the sagittal plane. The screws are sequentially tightened on insertion to prevent deformity or distraction at the fracture site. The wrist is immobilized for 6 weeks, followed by range-of-motion physical therapy or return to play. We achieved reliable fracture union in 100% of patients.
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