Abstract Title

FRACTURE OF THE FAR CORTEX DURING LARGE FRAGMENT SCREW INSERTION: A POORLY DESCRIBED MEANS OF SQUANDERING SCREW HOLES AND PLACING PLATE FIXATION AT RISK

Presenter Name

Bryan Ming

Presenter/Author(s) Information

Bryan Ming, JPSFollow
Cory Collinge MD

Purpose (a):

Design: Retrospective study of patient records and plain radiographs to determine the incidence and characteristics of iatrogenic fracture caused by screws themselves while using large fragment screw fixation

Methods (b):

Setting: Level II regional trauma center and tertiary referral center

Patients: Single surgeon cohort of patients treated surgically for acute fractures or fracture nonunions using large fragment plate and screw fixation.

Methods: Retrospective cohort retrieved from an experienced fellowship-trained orthopedic traumatologist’s billing database. Demographics, injury, and treatment details were obtained from patient’s medical and radiographic records.

Results (c):

Results: Seven instances of iatrogenic unicortical fracture of the distant cortex while using large fragment screw fixation was found in 246 cases, representing 3% incidence. Five were recognized and treatment altered by redrilling and applying a screw in a different trajectory (4), and in one case a plate was revised to a longer plate. In the two other cases, the fracture may have been unrecognized as the screw was left in situ.

Conclusions (d):

Conclusions: Unicortical fracture of the distant cortex around the pilot hole during screw insertion is poorly described iatrogenic complication, occurring in 3% of our cases where large fragment plate fixation was utilized. This circumstance suggests a few potential problem scenarios. First, some of these cases were unrecognized and the risk of treatment failure may be increased by loss of a screw’s purchase or by creation of a significant stress riser. Second, when the cases were recognized, measures were taken to improve stability, which included simply changing a screw’s axis, but also by revision by extending a plate in one case. Vigilant analysis of radiographs (both intraoperative and postoperative), focus on proper technique with placement of large fragment screws, and awareness of treatment options in the face of this uncommon complication can help minimize the impact of far cortical fracture.

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FRACTURE OF THE FAR CORTEX DURING LARGE FRAGMENT SCREW INSERTION: A POORLY DESCRIBED MEANS OF SQUANDERING SCREW HOLES AND PLACING PLATE FIXATION AT RISK