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Re: Pelvic and acetabular fracture
послал Milton L. Routt 06 Июль 2009, 21:53
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Probably bent.
I like bent screws when the fracture is clamped...blunt 3.5mm and even most 4.5mm cortical screws tend to bounce and bend if you insert them just right...but to bounce and bend the drill must avoid eroding the cortical bone, and blunt tipped screws are used...it’s also why I use a 2.5mm drill...it seems to be quite a flexible drill, especially if used in an oscillating mode.
Bent screws almost never “straighten out” after the clamp is released, but I always check with the C-arm as I release the clamp....sometimes if you use a single 3.5mm screw, it can change and just needs to be reclamped immediately and helped out with an additional screw.
Bent screws are “not-so-good” if the surgeon is using the lag screw to reduce the fracture...an unclamped fracture reduction always loses some when the screw bends as it’s terminally tightened...for extra-articular (acetabular-sparing) ramus fractures, the resultant slight malreduction seems clinically irrelevant thus far.
Thick screws (6.5-7.0-other such big ones) don’t bend much at all.
Remember, the ramus a very bent tube of bone in several planes with a variable sized straight osseus potential pathway for a screw or 2...it’s tough shooting sometimes, but typically very efficient, comfortable, strong, and durable fixation.
Thank you-
Chip
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