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Safe zone for the placement of medial 4.5mm Malleolar Screws

Background

The implantation of hardware for fracture fixation may result in soft-tissue structures being damaged or abutting one another. The prominence of the hardware after treating ankle fractures frequently causes pain. The goal of this study was to determine whether inserting a medial 4.5mm malleolar screw could harm or abut the posterior tibial tendon.

Methods

Skin dissection on ten unmatched cadaveric limbs that had been disarticulated at the knee revealed the medial malleolus. Using fluoroscopy and direct visualization of the deep fascia, three Kirschner wires were placed through the medial malleolus’ tip and directed parallel to the medial articular surface. The first wire was placed in the middle of the anterior colliculus. Two additional wires were positioned parallel and posterior to the first wire at 5-mm intervals. After being overdrilled, 4.0-mm screws were then inserted over the Kirschner wires. Researchers were able to examine the samples under a microscope to check for signs of trauma and determine how near the posterior tibial tendon the screws were. Three zones were created within the medial malleolus using anatomical landmarks. Zone 1 is the intercollicular groove, Zones 1 and 2 are the anterior and posterior colliculi, and Zone 3 is the posterior colliculus.

Results

Malleolar, 4.5mm A screw inserted in Zone 1 (the anterior colliculus) never made contact with the posterior tibial tendon in any of the specimens. Screws were typically positioned 2 mm away from the posterior tibial tendon in Zone 2 (the intercollicular groove). In all ten specimens, screws inserted in Zone 3 (the posterior colliculus) led to tendon abutment and injury.

Conclusions

When 4.5mm Malleolar Screws are inserted posterior to the anterior colliculus, there is a significant risk of injury or abutment to the posterior tibial tendon.

Different Types of Screws including 4.5mm Malleolar Screw

Locking Cortical Screws

• 2 mm Locking Cortical Screws
• 2.4 mm Locking Cortical Screws
• 2.7 mm Locking Cortical Screws
• 3.5 mm Locking Cortical Screws
• 5 mm Locking Cortical Screws

Cortical Screws

• 1.5 mm Cortical Screws
• 2 mm Cortical Screws
• 2.4 mm Cortical Screws
• 2.7 mm Cortical Screws
• 3.5 mm Cortical Screws
• 4.5 mm Cortical Screws

Locking Cancellous Screws

• 3.5 mm Locking Cancellous Screw
• 4 mm Locking Cancellous Screw
• 5 mm Locking Cancellous Screw
• 6.5 mm Locking Cancellous Screw

Cancellous Screws

• 3.5 mm Cancellous Screw
• 4 mm Cancellous Screw
• 6.5 mm Cancellous Screw
• Locking Cannulated Screws
• 4 mm Locking Cannulated Screw
• 5 mm Locking Cannulated Screw
• 6.5 mm Locking Cannulated Cancellous Screw
• 7.3 mm Locking Cannulated Cancellous Screw

Cannulated Screws

• 3.5 mm Cannulated Screws (Cortical Thread)
• 4 mm Cannulated Cancellous Screws
• 4.5 mm Cannulated Cancellous Screws
• 6.5 mm Cannulated Cancellous Screws
• 7 mm Cannulated Cancellous Screws
• 7.3 mm Cannulated Cancellous Screws

Headless Screws Full Thread

• 2.5 mm Headless Compression Screws Full Thread
• 3 mm Headless Compression Screws Full Thread
• 3.5 mm Headless Compression Screws Full Thread
• 4 mm Headless Compression Screws Full Thread
• 4.5 mm Headless Compression Screws Full Thread
• 5 mm Headless Compression Screws Full Thread
• 5.5 mm Headless Compression Screws Full Thread
• 6.5 mm Headless Compression Screws Full Thread

Headless Screws Partially Thread

• 2.5 mm Headless Compression Screws Partially Thread
• 3 mm Headless Compression Screws Partially Thread
• 3.5 mm Headless Compression Screws Partially Thread
• 4 mm Headless Compression Screws Partially Thread
• 4.5 mm Headless Compression Screws Partially Thread
• 5.5 mm Headless Compression Screws Partially Thread
• 6.5 mm Headless Compression Screws Partially Thread
• 7.5 mm Headless Compression Screw Partially Thread

Interlocking Nail Screws

PFNA2 Blades

PFNA Blades

• 8 mm Proximal Cannulated Bolt
• 6.4 mm Proximal Cannulated Bolt
• 4.9 mm Locking Bolts
• 3.9 mm Locking Bolts
• 3.4 mm Locking Bolts

Interference Screws

• 5 mm Interference Screw
• 6 mm Interference Screw
• 7 mm Interference Screw
• 8 mm Interference Screw
• 9 mm Interference Screw
• 10 mm Interference Screw

Herbert Screws

• 2.5 mm Cannulated Herbert Screws
• 3 mm Cannulated Herbert Screws
• 3.5 mm Cannulated Herbert Screws
• 4.5 mm Cannulated Herbert Screws
• 5.5 mm Cannulated Herbert Screws
• 6.5 mm Cannulated Herbert Screws

Craniomaxillofacial Screws

• 1.5 mm Screw Craniomaxillofacial
• 2 mm Screw Craniomaxillofacial
• 2 mm Locking Screw Craniomaxillofacial
• 2.5 mm Screw Craniomaxillofacial
• 2.5 mm Locking Screw Craniomaxillofacial
• 2.8 mm Screw Craniomaxillofacial
• 2.8 mm Locking Screw Craniomaxillofacial
• 2.7 mm Emergency Screw

Malleolar Screws

• 3.5 mm Malleolar Screws
• 4.5 mm Malleolar Screws

The most frequently used orthopedic implants are bone screws. For various types of bones, there are numerous types and sizes of screws. The majority of bone screws are constructed from titanium or stainless steel alloys. When determining screw mechanics, it’s important to consider the outer diameter, root diameter, thread pitch, and angle.

The outer diameter of screws is typically used in orthopedics to describe them; for instance, a “4.5mm Malleolar Screw” has an outer diameter of 4.5 mm. The linear distance covered by a screw during one complete turn is known as the pitch of the screw. With each full turn, the screw moves forward by a distance equal to the space between the threads. Cortical screws have more threads because they have a lower pitch. Given the fragility of the bone, cancellous bone screws have a deeper screw to increase surface area and enhance purchase.

Screws work by converting the torque applied to tighten them into internal tension and elastic responses in the bone around them. The fracture fragments that the screw is holding together are compressed as a result. Typically, screws are inserted into holes that have been drilled to the same diameter as the root and are either self-tapping or have been tapped (threaded) beforehand. The screws must be properly inserted into the proper size drilled hole and made to withstand the insertion torque levels anticipated in cortical bone because the torque to insert cortical bone screws can be high. Large, deep threads on cancellous bone screws allow them to securely hold the spongy bone. It is uncommon for a screw to fail during insertion due to the cancellous bone’s relatively low strength, but pull out can be problematic.

4.5mm Malleolar Screw Risk Factor

When assessing the prognosis in each case, contraindications—which may be partial or complete—must be taken into account. Under the following circumstances, alternative management strategies may need to be taken into account:

• infections that are systemic or local, acute or chronic.
• either localized, systemic, or chronic inflammation.
• serve as a dangerous vascular, nervous, or muscular disease.
• Bone defects that would prevent the implant from being properly anchored.
• All associated illnesses that might jeopardize the implant’s success and functionality.

Warnings and Precautionary for 4.5mm Malleolar Screw

The surgeon and support staff should read the safety instructions in this document as well as any product-specific information in the product description, surgical techniques, and/or brochures before using the 4.5mm Malleolar Screw.

Screws are designed, built, and produced with the utmost care using materials of the highest quality for medical use. If these high-quality screws are used properly, they guarantee the best working outcomes. As a result, the usage guidelines and safety advice below must be followed.

The incorrect use of a screw can result in injury to the operator, patients, or other people as well as tissue damage, premature wear and tear, instrument destruction, and instrument destruction.

The operating surgeon must actively participate in the medical care of their patients. The surgeon must have a complete understanding of the instruments, their limitations, and the surgical procedure. The surgeon and the surgical team are responsible for exercising caution in the selection and use of surgical instruments. Before using implants, adequate surgical training should be obtained.

Factors that could harm the operation’s success include:

• allergies to materials implanted.
• regional bone tumors.
• osteomalacia or osteoporosis.
• metabolic disturbances and systemic disease.
• drug and alcohol abuse.
• Excessive shock-producing physical activity that exposes the implant to blows and/or heavy loads.
• Patients who lack the mental capacity to comprehend and follow instructions from a doctor.
• Unhealthy overall.
• Potential Negative Effects

The most frequent side effects following implantation are as follows:

• screw loosening that may be caused by the implant’s tissue reaction or by the fixation site’s repeated loading.
• the two stages of infection.
• additional bone fracture brought on by abnormal stress or weakened bone structure.
• a hematoma or pressure-related pressure that causes temporary or permanent neural damage.
• Hematomas from wounds and slow wound healing.
• Venous thrombosis, pulmonary embolism, and cardiac arrest are examples of vascular disease.
• heterotopically ossifying.
• Due to the 4.5mm Malleolar Screw’s presence, there is pain and discomfort.
• Implant mechanical failure, such as bending, loosening, or breakage.
• Implant migration leading to injury.

Preoperative Planning for 4.5mm Malleolar Screw

Following a thorough clinical evaluation of the patient, the operation is planned. X-rays are also necessary to provide a clear picture of the bony anatomy and any associated deformities. A full size 4.5mm Malleolar Screw as well as the appropriate implantation tools must be on hand at the time of the procedure.

The potential risks and complications related to the use of implants should be discussed with the patient by the clinician. If the patient has allergies to any of the implant materials, it is crucial to know this before surgery. Additionally, the patient needs to be made aware that the device’s performance cannot be guaranteed because problems may reduce its lifespan.

4.5mm Malleolar Screw Precautions

During reprocessing, verify that the instruments are functional and look for wear. Before using, replace any worn-out or broken instruments.

It is advised to use the tools designated for this screw.

Use caution when handling equipment, and put used bone-cutting tools in a sharps container.

Always use suction and irrigation to remove any debris that may be produced during implantation or removal.

4.5mm Malleolar Screw Warnings

Malleolar, 4.5mm During use, a screw may break (if excessive forces are applied). We advise that the broken part be removed whenever possible and practical for the particular patient, though the surgeon will ultimately decide whether to do so based on the risk involved. Be aware that implants lack the natural bone’s strength. Significant loads may cause implants to fail.

The user’s glove or skin may be pinched or torn by the sharp edges or moving joints of some instruments, screws, and cut plates.

Be sure to get rid of any fragments that weren’t fixed during surgery.

While the surgeon will ultimately decide whether to remove the implant, we advise that fixation devices be taken out as soon as it is safe and practical for the specific patient and after their purpose as a healing aid has been fulfilled. To prevent refracture, implant removal should be followed by adequate post-operative care.

4.5mm Malleolar Screw General Adverse Events

There are risks, side effects, and adverse events associated with all major surgical procedures. While there are many possible reactions, the following are some of the most frequent ones: issues related to anesthesia and patient positioning (such as nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, damage to nerve and/or tooth roots or other critical structures, such as blood vessels, excessive bleeding, damage to soft tissues, including swelling, abnormal scar formation, functional impairment of the musculoskeletal system, and pain.