Treatments & Therapies

Screw osteosynthesis – treatment, effects & risks

Screw osteosynthesis

Screw osteosynthesis is the screwing and bridging of bone fractures (fractures) with foreign material in the form of screws. The screws used for this are made of surgical steel, titanium or similar materials.

What is screw osteosynthesis?

This form of osteosynthesis is a commonly used method for internal anatomical refixation of fractures or fracture fragments (fragments). The advantage of this method is that usually only a minimally invasive surgical procedure has to be performed. In addition, dislocated fractures (e.g. ankle joint) lead to only a small loss of the joint surface.

The aim of the screw connection is to fix the fractures or fragments until they have healed. Resulting axis and joint misalignments are corrected during refixation. The advantage over non-surgical (conservative) treatment methods is that the anatomy can be restored accurately and specifically. The fractured area can be quickly exercised, moved and, depending on the complaint, fully loaded. In this way, movement restrictions and muscle atrophy can be prevented. Movement reduces the risk of thrombosis.

Function, impact & goals

Screw osteosynthesis is mainly used in surgery and orthopaedics when conservative treatment is not possible. This is the case, for example, if it is an open fracture. The procedure is performed under anesthesia. This can be plexus anesthesia, spinal anesthesia or general anesthesia. The duration of such an operation depends on the degree of injury. The stay in the hospital then amounts to a few days, whereby the later material removal can also be carried out on an outpatient basis.

The treatment of an open fracture by means of screw osteosynthesis significantly reduces the risk of subsequent bone or soft tissue inflammation. In the case of thigh and lower leg fractures, conservative treatment is possible, but osteosynthesis makes more sense. Due to the internal stabilization, the affected lower extremity is immediately stable postoperatively. This means that the patient can freely move and exercise the limb. After a few days of practice, the leg can be fully loaded, depending on the state of pain.

If there is a polytrauma, multiple fracture or debris fracture, the fracture fragments are repositioned and fixed. Basically, fractures with displaced fracture fragments are treated with screw osteosynthesis. The goal here is always to reposition and fix the displaced fragments and restore any joint functions in their anatomical axis.

Screw osteosynthesis is not only used for trauma-related fractures. Other areas of application include orthopaedics. Specifically severed bones are fixed by this method for alignment in the event of axis malpositions (e.g. X– or O-legs).

Furthermore, osteosynthesis is used for arthrodesis (joint stiffness), general instability or instability after tumor removal. But even in the case of soft tissue injuries, screw osteosynthesis is sometimes preferred to plate osteosynthesis. The operational process is as follows: As soon as the surgeon has gained access to the fractured area, the fracture fragments are aligned with each other in the correct position. In the actual fixation of the fracture, a distinction is made between cortical screws and spongiosa screws. Both are so-called tension screws, these are intended to pull the breaking point together.

The difference is that the Spongiosa screw has a short shaft and is screwed in the epiphyseal area. The operating doctor drills the cortex of the bone so that a spongiosa screw fits into the hole. In the opposite fragment, a smaller hole is drilled, into which a thread for the screw is cut with a special instrument. Now the screw is screwed into the holes and so the bone piece is pulled with the thread against the bone piece with the simple hole. By tightening the screw, the fracture fragments are firmly connected to each other.

The cortical screw, on the other hand, is screwed in the diaphyseal area. Compared to the Spongiosa screw, this has a long shaft and a short thread at the lower end. Here, too, the surgeon drills a hole in the bone into which the screw comes. This is now screwed in so that the thread is behind the break line. As with the Spongiosa screw, the cortical screw pulls both fracture fragments together and thus fixes them.

Risks, side effects & dangers

The treatment by a screw osteosynthesis is always associated with a surgical procedure. This increases the risk of infection, because a closed fracture becomes an open fracture and germs can penetrate, the risk of infection increases. In addition, it can lead to functional limitations, This increases the risk of infection, , wound healing disorders,pseudarthroses, instability and arthrosis.

Possible serious complications can be loosening or breaking away of the implant due to material failure. As a result, the fracture fragments can slip and as a result have malpositions or shortened extremities. In order to prevent this, a regular follow-up should take place with the treating surgeon or orthopedist, with the control by imaging procedures. Postoperative bleeding, scarring with adhesions can, as with any surgical procedure, also occur here. General risks of anaesthesia, especially in elderly patients with poor general condition, such as , cardiovascular complaints,disturbance of breathing, etc. should always be taken into account.

In addition, a further surgical procedure must be carried out for material removal. Often the material is not removed in older patients, as the bone material usually does not become as solid as before. Otherwise it can lead to a so-called refracture. In children, however, the material must be removed soon after the fracture has healed, as the bones are still growing.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.