Dr.Parthasarathy.M.P.

structure
Types Insertion Holding Clinical

power of the screw

considerations

 Head
Counter Shaft Run

sink

out Thread Root diameter Pitch Lead Thread diameter Thread design Tip

 Screw

head recess@ 4 design

1.single slot head: -inefficient design -torque acts at two points -standard screw driver 2.cruciate head: $ -two slots at right angles $-exact fit

3.Phillips head: -secure cross slot -torque acts at 4 pts of contact

4.Recesseed hexagonal head: -most prevalent design -acts at 6 pts of contact

 Applying
Acts

torque to the screw

as a stop,compression between the surfaces develops.

 defn@under
Shape

surface of the head

@ conical or hemi spherical Conical under surface: -insert centred &perpend to hole/plate - used to produce compression effect hemi spherical under surface: -screw can be angulated in all directions -concentric contact between screw & plate

 Variable
Std

cortical bone screw-non existent shaft; lag screws

Long

smooth shaft has no purchase in the proximal hole & ensures compression by lagging

 Transitional
Represents

area

a location of significant stress concentration@ stress riser Abrupt changes in diameter @sharp corners
Screw

may break at run out during insertion. incorrectly centered Inadequately tightened plate screw construct

 Long

inclined plane or a wedge encirclng a

Small applied torque

core.

Large internal tension compresssion between the surfaces held together

 Std

orthopaedic screw@ single thread

may have Two or more sets of threads

Screw Double

thread screw @ ^advances fast ^inefficient as it consumes more torsional energy

 Core

/inside/root.

Narrowest

diameter of screw across base of the threads part of the screw.

Weakest Smaller

the root diameter,greater tendency to shear off during insertion /removal

Torsional strength of S

Cube of root diameter

Extent of torque

Doubling the root diameter Square of its diameter

Tensile strength

 Distance

between the adjacent threads

Fine thread Small pitch

Cortical screw

Cancellous screw

Coarse thread

Larger pitch

Thread

pitch determines the rate of advance of screw(lead) thru a material .

 In

a cortical bone screw pitch measures 1.75 mm. and this is also expressed as the
AO cortical screw 40.5 tpi

THE NO .OF THREAD PER INCH.tpi

AO cancellous screw

9.2 tpi

 Distance
Screw

it travels on one complete turn.

with single thread,lead=pitch.

Smaller

the lead(eg;stronger cortical screws),greater the mechanical advantage of the screws

 Out
It

side diameter@maximum thread width

affects the pull out strength of the screw Larger the outside diameter greater the resistance to pull out . Larger the size & surface area of the screw,greater the holding power.

V profile and BUTTRESS profile.

60

Angle

45

Both sides

slanted

Only one side

Compression & shear

Force production at the bone thread junction

compression

 Four
Self Non

types

tapping tip Self tapping tip

Cock

screw tip
tip

Trocar

 Flute#thread
Flute

cutting device.

cutting edge / channels. is the maiin advantage.

Simplicity Can

be removed and re inserted safely.

 Thread

extends upto tip. Rounded tip accurately guides the screw into the pre tapped hole.
Pilot

hole .- TAP. torque is produced.

Efffective Higher

interfragmental compression Extensively used in cortical bone

 Cock

screw tip: in cancellous screws where the tip clears the pre drilled hole. thread forming screws only suitable for use in cancellous screws. trocar tip@ displaces the bone as it advances eg:malleolar screw-distaltibia/medial malleolus schanz screws,locking bolts-im nails

 DESIRABLE

QUALITIES OF SCREW

-Easy to insert & remove. -good purchase on the bone.

-strong to with stand tensile ,torsional

,shearing stresses during use & applications

 Cortical Self

and cancellous screws

tapping @ non self tapping screws and partially threaded screws

Fully

Cannulated
Herbert

screws

screws

 Drill

bit Drill sleeve Drilling depth Pilot hole Measurement of length. Tapping Washers

Drill bit: -drilling -PILOT HOLE: surgical pins /drill pilot hole first step same diameter importance: 1.the screw may break if the hole is too small 2.holding power of screw increases progressive smaller holes. 3.hole with the 90% of the thread diameter of the screw Is optimal

Mechanism of drilling
drill point should be sharp. If it is blunt wobbles / thermal necrosis of bone. Close fitting drill sleeve Once drilling angle is established ,maintain it during drilling , tapping, placement of the screw.

 Drill

bit failure:3- 25drill bits per 1000 internal fixations Causes: 1.touching an implant. 2.rotational bending failure. Occurs during: -insertion of hip screw. Measurement of length: depth gauge

 Depends

on how it is tested

1.measurement

of the pull out strength

2.measurement of the maximal axial tension

 How

to determine ??

pulling the screw along its longitudinal axis and the force required to rip the threads is measured. of both the SIZE OF THE SCREW & NO OF SCREWS engaged. in units of newton/mm.

Function

Specified

 Depends

on the Screw and the material in which the hole is situated Others: thread area. core area. thread profile no.of.threads engaged. hole size. shear strength of the bone. tissue reactions & bone growth

 1.lag

screw-compress fract.fragment together

screw

2.placement 3.to

buttress a fracture

 Most

effective way to achieve comprerssion between two fragments

the fragments together @pressure across the fracture line.

Pulls

PRINCIPLE@

SCREW MUST GLIDE FREELYTHRU THE NEAR FRAGMENT AND ENGAGAE ONLY IN THE FAR FRAGMENT.