I can't figure out what kind of screws these are in 2/3- one person said it is a detachable biomet screw. Any more information on it? Was it for a corrective osteotomy?
Can Someone ID this Screw?
- Thread starter basupran
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Could be one of any number of snap-off screws. It looks like the head has two drive slots.
Maybe Tornier screws?
http://tornierdx.com/pdf/19-5062-b%20Snap%20Off%20Surgical%20Technique.pdf
Weil osteotomy.
Maybe Tornier screws?
http://tornierdx.com/pdf/19-5062-b%20Snap%20Off%20Surgical%20Technique.pdf
Weil osteotomy.
Yeah, could be any brand of snap off... prob the Tornier one mentioned above or Arthrex QuickFix? It's a copycat industry; that's for sure.
That's some serious splay foot...see if you can get the pt to go sign a records release to get their op report from the doc, hospital, or surg center where they had the orig procedure? In my pgy1 year, I obviously get stuck with most of the I&Ds and HWRs, and I've found that many many hours struggling through unknown fixative HWR cases with the wrong screwdriver or the broken screw set could've been saved by having the pt do a bit of pre-op legwork.
That's some serious splay foot...see if you can get the pt to go sign a records release to get their op report from the doc, hospital, or surg center where they had the orig procedure? In my pgy1 year, I obviously get stuck with most of the I&Ds and HWRs, and I've found that many many hours struggling through unknown fixative HWR cases with the wrong screwdriver or the broken screw set could've been saved by having the pt do a bit of pre-op legwork.
I thought about the Arthrex QF but I think they have three drive slots. The screw in the 2nd met doesn't even appear to have a head. DuPuy has a snap-off screw that is completely fusiform and headless.
Good call on the records release. If the person who dictated the Op Report didn't include the name of the hardware then the nurses record will have it, as they have to record the hardware with sizes and serial numbers when available. Make sure to ask for the nursing records.
Basupran, are you planning to remove the hardware or just re-do the bunionectomy (or neither)? The x-ray seems distorted. Is it an oblique view or was the photo taken at an odd angle?
Thanks for the input! It was more out of curiosity as I couldn't get an answer- wasn't too sure why they did the 2nd/3rd osteotomy in the first place (can anyone explain?). I don't have preop films but one specific foot/ankle attending tends to do multiple osteotomies with the hallux valgus repairs while most of the others don't.
Sorry about the poor picture quality, I snapped it with my cell phone.
We don't plan on doing a removal of hardware- I just haven't done a foot/ankle rotation yet and was asked to comment on foot films with hardware I couldn't recognize. Can't get an op note.
Any further input would be greatly appreciated.
Sorry about the poor picture quality, I snapped it with my cell phone.
We don't plan on doing a removal of hardware- I just haven't done a foot/ankle rotation yet and was asked to comment on foot films with hardware I couldn't recognize. Can't get an op note.
Any further input would be greatly appreciated.
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Just fyi...
If the 1st met is shorter than the 2nd or the procedure shortens the 1st met significantly compared to the 2nd some attendings will shorten the 2nd met. In order to maintain the metatarsal parabola sometimes the 3rd must also be shortened. In residency we had an attending that would shorten 2-4 or none at all. The theory was that the intrinsics have a change of balance when not all mets are shorten together.
The surgeon probably did the lesser metatarsal osteotomies to address weightbearing forces across the metatarsal heads.
Sometimes when you do a hallux valgus/bunion correction it results in a relatively short 1st metatarsal, which causes abnormal force distribution across the ball of the foot during the propulsion phase of gait. Ground reaction force gets "dumped" laterally to the 2nd (and maybe 3rd) metatarsal heads and the patient may develop pain at the lesser metatarsal heads over time. The lesser metatarsal osteotomy (aka, Weil osteotomy) shortens and/or elevates the metatarsal. You want to have a nice parabola across the metatarsal heads in which they have a good length relation to one another. The ideal relative lengths are 2>1=3>4>5. If the 1st met gets shortened so that it is more than 3mm or 4mm shorter than the 2nd, there is an increased chance of transfer pain.
Another scenario is that pre-operatively a lesser metatarsal is plantarflexed relative to the adjacent metatarsals. The Weil osteotomy tries to adjust the weighbearing pattern as I explained in the preceding paragraph. Ideally the met-heads all come to rest in the same plane at normal angle and base of gait.
The Weil osteotomy can also address transverse plane toe malalignment by shifting the lesser metatarsal head medially and laterally. Say the 2nd toe is adducted towards the hallux. You can straighten it by shifting the 2nd met-head medially a bit.
