Cannulated Screw Fixation. Principles and Operative Techniques

Transcription

1 Cannulated Screw Fixation Principles and Operative Techniques

2 Springer New York Berlin Heidelberg Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo

3 Stanley E. Asnis, M.D. Richard F. Kyle, M.D. Editors Cannulated Screw Fixation Principles and Operative Techniques With 190 J1/ustrations Springer

4 Stanley E. Asnis, M.D. Department of Orthopaedics Cornell University Medical College Hospital for Special Surgery New York, NY 10021; and North Shore University Hospital Manhasset, NY 11030, USA Richard F. Kyle, M.D. Department of Orthopaedic Surgery University of Minnesota Chairman Department of Orthopaedic Surgery Hennepin County Medical Center Minneapolis, MN 55404, USA Library of Congress Cataloging-in-Publication Data Cannulated screw fixation: principles and operative techniques / (edited by) Stanley E. Asnis, Richard F. Kyle. p. cm. Includes bibliographical references and index. ISBN -13: e-isbn -13 : DOl: / Bone screws (Orthopedics) 2. Internal fixation in fractures. I. Kyle, Richard F. II. Asnis, Stanley E. (DNLM: 1. Bone Screws. 2. Fracture Fixation, Internal-methods. HE 185 T ) RD103.I5T B17.1'B-dc20 DNLMjDLC for Library of Congress CIP Printed on acid-free paper Springer-Verlag New York, Inc. Softcover reprint of the hardcover 1 st edition 1996 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Chernow Editorial Services, Inc. and managed by Karen Phillips; manufacturing supervised by Joe Quatela. Typeset by Asco Trade Typesetting Ltd., Hong Kong ISBN -13:

5 To Elaine, the most talented individual whom I have ever known. A person with the amazing ability to bring out the best in anyone who was lucky enough to know her. You are the one to whom lowe everything. Elaine, you will always be my best friend, my most beautiful rose, my true companion. With all my love, now and forever, Stan

6 Preface Bone screws are among the oldest means of internal fixation for fractures. Despite the continual use of these amazing machines, our understanding of the mechanical principles of the screw-bone complex in fracture care is still limited but rapidly growing. Chapters 1 and 2 reexamine the principles of screw biomechanics as well as the characteristics of the materials and techniques used to manufacture screws. With the advent of improved radiographic techniques, image intensified fluoroscopy, and computed tomography, the surgeon can better understand the fracture that he is presented with and plan appropriately. With a cannulated screw system and intraoperative fluoroscopy, the surgeon can frequently limit his exposure and still obtain very accurate screw placement. Chapter 3 deals with the radiation to the patient and physician and methods to minimize exposure. The remainder of this book gathers the clinical experience and techniques of experts of fixation in the different anatomical areas. The knowledge of internal fixation is rapidly growing. It is our goal to give the reader an update on the understanding of cannulated screw fixation principles as well as specific clinical techniques. The clinical chapter authors give their preferred screw systems and procedures; however, they realize that there are many variations that can be successfully employed. The orthopaedic surgeon is encouraged to apply those basic principles of cannulated screw fixation that apply to each specific case and use his initiative to best fix the fracture. This will help to improve our skills and increase our knowledge of this old but most-challenging field of medicine-fracture care. Stanley E. Asnis, M.D. Richard F. Kyle, M.D. vii

7 Foreword For the last decade, cannulated screws have crept quietly into a place of prominence and utility in contemporary orthopaedic surgery. Despite their pivotal role as an adjunct to the new minimally invasive surgery, they have not been formally recognized as have their cousins -the plate, intramedullary nail, and external fixator. Dr. Stanley E. Asnis pioneered the development of cannulated screws for the fixation of femoral neck fractures in the early 1980s and has worked steadily to expand the indications and perfect the technique for their use. The thoroughness and detail of this reveal his high level of scholarship book and focused expertise. The text begins with a group of chapters on materials, manufacturing, biomechanics, and radiation safety. The remainder of the chapters cover individual anatomic areas and pathologic entities, where cannulated screws can be employed to great advantage. Comprehensive scientific discussions and extensive technical information contained in the text are complimented by numerous excellent illustrations. Dr Asnis and an experienced group of contributors provide formal recognition for the now wellestablished technique of cannulated screw fixation by bringing together its many technical nuances under a single cover. Along with the arthroscope and image intensifier, the cannulated screw has been a major facilitator of minimally invasive surgery. In the past, screw fixation of fractures usually required extensive surgical exposure of bone fragments and substantial soft tissue stripping. This resulted in increased postoperative pain and a greater risk of infection and nonunion. The success of operative arthroscopy has opened a new era of minimally invasive surgery. In comparison to open arthrotomies, the use of multiple small incisions for arthroscopy portals has led to rapid patient recovery and lower complication rates. Continued improvement in image intensification and development by manufacturers of a wide array of cannulated screws has permitted many fractures that previously required open surgery to be fixed percutaneously. Reduction of fractures can be achieved with radiographic control and provisionally fixed with the cannulated screw guide wire. Because the cannulated screw is inserted over the guide wire, the surface area of bone that must be stripped of soft tissue need only be slightly larger than the diameter of the screw. Manufacturing steps necessary to produce the cannulated screw make them ten times more expensive than an equivalent screw without cannulation. Use of this more expensive implant is more than justified if it allows a patient to be treated with minimally invasive surgery. As cost reduction of medical care is now a national priority, it is incumbent on surgeons to avoid gratuitous expenses in implant selection. The use of cannulated screws during open reduction, which affords broad exposure of bone fragments, is not warranted. Fixation can usually be accomplished by traditional methods that employ provisional Kirschner wire fixation and standard lag screws. Read carefully, the information in ix

8 x Foreword this book can steer orthopaedic surgeons to the proper indications and correct use of this new technology. Bruce D. Browner, M.D. Gray-Gossling Professor, Chairman Department of Orthopaedics University of Connecticut Health Center and Director of Orthopaedics Hartford Hospital

9 Contents Preface Foreword by Bruce D. Browner Contributors vii ix xiii 1 Materials and Manufacturing of Orthopaedic Bone Screws... ; lens ]. Ernberg and Stanley E. Asnis 2 Biomechanics of Cannulated and Noncannulated Screws Allen F. Tencer, Stanley E. Asnis, Richard M. Harrington, and lens R. Chapman 3 Fluoroscopic Procedures in Orthopaedics: Radiation Exposure of Patients and Personnel W. Gordon Monahan 4 Intracapsular Hip Fractures Stanley E. Asnis and Richard F. Kyle 5 Slipped Capital Femoral Epiphysis Stanley E. Asnis 6 Acetabular Reconstruction with Allografts Utilizing Cannulated Screws Bruce A. Seideman and Stanley E. Asnis 7 Pelvic and Acetabular Fractures Dana C. Mears 8 Cannulated Screws for Pelvic Fractures David L. Helfet and Neel Anand 9 Internal Fixation of Sacral Fractures David C. Templeman and Paul l. Duwelius 10 The Knee: Tibial Plateau Fracture Reduction Techniques Utilizing Cannulated Screw Fixation Paul l. Duwelius and David C. Templeman 11 The Knee: Arthroscopic Surgery with Cannulated Screw Fixation Robert E. Schwartz 189

10 xii Contents 12 Use of Cannulated Screws in Anterior Cruciate Ligament Reconstruction Nicholas A. Sgaglione 13 Ankle Fractures Stanley E. Asnis and Mathias P. G. Bostrom 14 Composite Fixation for Juxtaarticular Fractures Lon S. Weiner and Eric C. Mirsky 15 Ankle Arthrodesis Arthur K. Walling and Brian J. Padrta 16 The Foot Charles N. Cornell 17 The Spine Robert A. McGuire, Jr. 18 The Shoulder David M. Dines, Stanley E. Asnis, and Alexandra Page 19 Fractures About the Elbow Jesse B. Jupiter Index

11 Contributors Nee! Anand, M.D. Senior Clinical Associate, Department of Orthopedic Surgery, Cornell University Medical College, Hospital for Special Surgery, New York, NY 10021, USA Stanley E. Asnis, M.D. Clinical Associate Professor, Department of Orthopaedic Surgery, Cornell University Medical College, Hospital for Special Surgery, New York, NY 10021; and North Shore University Hospital, Manhasset, NY 11030, USA Mathias P.G. Bostrom, M.D. Senior Clinical Associate, Department of Orthopedic Surgery, Cornell University Medical College, Hospital for Special Surgery, New York, NY 10021, USA lens R. Chapman, M.D. Assistant Professor, Department of Orthopaedic Surgery, University of Washington, Harborview Medical Center, Seattle, WA , USA Charles N. Cornell, M.D. Associate Professor of Surgery, Cornell University Medical College, Hospital for Special Surgery, New York, NY 10021, USA David M. Dines, M.D. Clinical Assistant Professor, Department of Orthopaedic Surgery, Cornell University Medical College, Director, Division of Orthopaedic Surgery, North Shore University Hospital, Manhasset, NY 11030, and Hospital for SpeCial Surgery, New York, NY 11021, USA Paul]. Duwelius, M.D. Assistant Professor, Division of Orthopaedics and Rehabilitation, Oregon Health Sciences University, Portland, OR , USA lens I. Ernberg, M.S. Design Engineer, Department of Biomedical Engineering, Hospital for Special Surgery, New York, NY 10021, USA Richard M. Harrington, M.S. Research Engineer, Department of Orthopaedics and Biomechanics, University of Washington, Harborview Medical Center, Seattle WA , USA xiii

12 xiv Contributors David L. HelJet, M.D. Associate Professor, Department of Orthopaedic Surgery, Cornell University Medical College, Director, Orthopaedic Trauma, Hospital for Special Surgery, New York, NY 10021, USA Jesse B. Jupiter, M.D. Associate Professor, Department of Orthopaedic Surgery, Harvard Medical School, Director, Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA 02114, USA Richard F. Kyle, M.D. Associate Professor, Department of Orthopaedic Surgery, University of Minnesota, Chairman, Department of Orthopaedic Surgery, Hennepin County Medical Center Minneapolis, MN 55404, USA Robert A. McGuire, Jr., M.D. Professor of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA Dana C. Mears, M.D., Ph.D. Clinical Associate Professor, Department of Orthopaedic Surgery, University of West Virginia, Shadyside Hospital, Pittsburgh, PA 15232, USA Eric C. Mirsky, M.D. Senior Orthopaedic Resident, Department of Orthopaedic Surgery, Mount Sinai School of Medicine, New York, NY 10021, USA W. Gordon Monahan, Ph.D. Director of Medical Physics, Department of Radiology, North Shore University Hospital, Manhasset, NY, 11030, USA Brian J. Padrta, M.D. Foot and Ankle Fellow, Tampa Orthopaedic Program, Tampa, FL 33617; and Northwest Orthopaedic and Fracture Clinic, Sacred Heart Doctors Building, Spokane, WA 99204, USA Alexandra Page, M.D. Clinical Associate, Department of Orthopaedic Surgery, Cornell University Medical College, Hospital for Special Surgery, New York, NY 10021, USA Robert E. Schwartz, M.D. Clinical Instructor, Department of Orthopaedic Surgery, Cornell University Medical College, North Shore University Hospital, Manhasset, NY 11030, USA Bruce A. Seideman, M.D. Clinical Instructor, Department of Orthopaedic Surgery, Cornell University Medical College, North Shore University Hospital, Manhasset, NY 11030, USA Nicholas A. Sgaglione, M.D. Clinical Assistant Professor, Department of Orthopaedic Surgery, Cornell University Medical College, North Shore University Hospital, Manhasset, NY 11030, USA David C. Templeman, M.D. Associate Professor, Department of Orthopaedic Surgery, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN 55415, USA

13 Contributors xv Allen F. Tencer, Ph.D. Research Engineer, Department of Orthopaedics and Biomechanics, Harborview Medical Center, University of Washington, Seattle, WA , USA Arthur K. Walling, M.D. Director, Tampa Orthopaedic Program, and Head, Section of Foot and Ankle Surgery, Florida Orthopaedic Institute, Tampa, FL 33617, USA Lon S. Weiner, M.D. Chief of Trauma, Department of Orthopaedics, Lenox Hill Hospital, New York, NY 10021, USA