Surgical screws are critical for stabilizing bones and promoting healthy healing from simple fractures to complex joint injuries. With many designs and applications, selecting the appropriate screw is crucial for successful orthopedic surgery outcomes. In this post, we’ll delve into the most common types of surgical screws and their specific applications in the fixation of body fractures, including:
- Pedicle
- Cortical
- Cancellous
- Cannulated
- Locking
- Lag
- Self-tapping
We’ll also offer guidance for selecting the best surgical screw for your needs. So, whether you’re a medical professional or simply interested in learning more about orthopedic surgery, this article will ‘drill’ into the helpful basics of surgical screws.
Pedicle Screws
Body fractures: Spinal fusion
Pedicle screws are a type of surgical screw used in spinal fusion surgeries, such as scoliosis, kyphosis, and degenerative disc disease, to provide stability and support to the spine. These screws are inserted through the pedicles, the small bony protrusions that connect the vertebral body to the facet joints of the spine. Research shows that pedicle screw fixation in lumbar fusion surgery has a low rate of complications, radiographic failure, and repeat surgery, with good functional capacity and patient satisfaction over a minimum 10-year follow-up.
Cortical Screws
Body fractures: Skull, femur, tibia, humous, hand, foot
Cortical screws are essential in repairing fractures in the hard outer layer of bones, such as the skull. They are also ideal for stable fractures, including simple, oblique, and transverse fractures, and are often applied to the femur, tibia, humerus, hand, or foot. These screws are designed to fix cortical bone surrounding the softer, spongy cancellous bone. With a tapered shank and a flat head, cortical screws can be countersunk into the bone without causing irritation or impinging on surrounding soft tissue.
Cancellous Screws
Body fractures: Femoral neck, ankle, vertebral body, pelvis
Cancellous screws treat fractures of the spongy bone. These screws are specifically designed to fix the cancellous bone found in the inner part of bones, which is more porous and permeable than cortical bone. With a coarser thread than cortical screws, cancellous screws are better suited for anchoring into the softer cancellous bone, making them ideal for less stable fractures requiring compressions, such as those in the vertebral bodies of the spine or the hip femoral neck.
Cannulated Screws
Body fractures: Neck, tibia, fibula, hand, foot
Cannulated screws are a game-changer for accurately placing screws in bone fractures, from long bones such as the femur and humerus to smaller bones in the hand and foot. These hollow screws are threaded over a guide wire inserted into the bone first, ensuring precise placement even in cases where the surgical site has limited visibility. This feature makes them a go-to option in minimally invasive surgeries or fractures close to nerves or blood vessels.
Locking Screws
Body fractures: Osteoporotic, near-joint, high-risk patients
Locking screws are suited for fixing fractures in bones near a joint where the screw may be subject to bending or shearing forces. These screws are specifically designed to lock into a plate or nail, providing greater stability and reducing the risk of implant failure. Unlike traditional screws, locking screws do not rely on the bone’s strength to hold the screw in place, making them ideal for patients with poor bone quality or at higher risk of implant failure.
Lag Screws
Body fractures: Distal femur, ankle, bone grafting
Lag screws are a type of surgical screw for fixing fractures requiring compression or joining two bone fragments together, from fractures of the distal femur to those in the ankle joint. These screws have a unique design, with a threaded head and a smooth shank that allows them to slide through the bone without causing excessive damage while compressing the bone fragments together. They can also be used to fix bone grafts in place or correct surgical deformities.
Self-Tapping Screws
Body fractures: emergencies, clavicle, hand, foot
Self-tapping screws have a sharp tip that makes insertion more accessible and are often used when trauma to the bone must be minimized or when a pre-drilled hole is not possible. These screws are ideal for achieving stable fixation quickly, such as in emergency surgery or when the bone is too hard to allow easy insertion of a screw. From fractures of the clavicle to those of the hand or foot, self-tapping screws have multiple applications in orthopedic surgery.
There are many variations of each of these types of screws, and the specific type of screw used in a surgical procedure will depend on several factors we’ll introduce in the next section.
How to choose the best surgical screw for the proper fixation of fractures
When selecting a surgical screw for proper fracture fixation, it is crucial to consider the following factors:
- Fracture type
- Fracture location
- Patient’s overall health
Choosing the appropriate screw can optimize surgical outcomes and promote faster healing. However, all surgical screws carry risks, and patients must follow their surgeon’s post-operative instructions to avoid complications and recover properly. Consulting with an experienced spinal surgeon can also help determine the treatment for each patient’s needs.
For more, download our Comprehensive Guide to Surgical Screws for Different Body Fractures. This resource digs deeper into the surgical screws mentioned in this post. In addition, it offers a glimpse into the complex and precise surgical screw manufacturing process, from design and specification to packaging and sterilization.
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Browse our contract manufacturing services for the medical industry, our downloadable Comprehensive Guide and our stringent Quality Systems on our website or contact us for personalized assistance with your medical manufacturing challenges.
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