I am working on research and need opinions and reasons on why foot and ankle surgeons use cannulated screws. They are more expensive to the health care network and they are not as strong as non cannulated screws. Are they used because of surgeons training or lack there of and ease of use. Are they worth 10X as much cost as solid screws? Please give me your honest opinions and any research you know of on this topic.
Comfort in putting screw over pre placed guidewire saves time and sometimes iatrogenic local trauma and is major factor in choosing to do so. Cost is other variàble but can be curtailed by using multiple K wires in place of screws at certain places. Surgeon's discretion may be affected by most of the teaching courses or workshops advocating cannulated method of fixation.
Ganesh thank you for the answer. If a surgeon has skills isn't the trauma of a 4.0 cannulated screw the same a 4.0 solid screw? Your thought process is the same as mine.
Good day. One more advantage of cannulated screws is possibility to use preliminary pinning of bone fragments in required position. We use cannulated screw in reconstructive foot surgery in CP patients.
An excellent Question.
I agree with Dr G.S. Dharmshatku, regarding being comfortable putting cannulated screws over pre-placed guide-wire reduction, after checking with image intensification, thus reducing the chance of iatrogenic issues or intra-articular placement.
Secondly, one could place a 'set' screw after compression, but many cannulated compression screws do this, thus satisfying one of the basic principles more efficiently. (With less operative or tourniquet time)
Thirdly, some screw placements in complex cases or trauma, may be placed percutaneously, to protect the skin and healing, and cannulated screws would be ideal for percutaneous fixation.
As in all trauma, the principles of skin and wound handling and care should be respected, more so in the distal foot and ankle circulation, in an elderly population, that often has other vascular co-morbidities.
So, cannulated screws may reduce operative time, may reduce the size of the wound, or the size of the skin flap, and would be beneficial if they address these issues.
Very interesting question.
Cannulated screw system provide emergency closed reduction, percutaneous screw fixation and excellent stability.
Cannulated bone screws in comparation with traditional screws decrease surgical time, allow more precise screw placement and reduce possibility of errors.
i hope a good day for you all, l also i think the purchase of non cannulated 4mm sold screws is more better if i have the skills to put it correctly, but cannulated one easy to be used
With the huge cost difference I personally feel they are over used. I agree with all that have said they are great for trauma and percutaneous reduction. That being said if a surgeon has skills they shouldn't need them in other cases. Not only are they expensive but when used bicortical for strength, which a high percentage of them are, the cutting tip is very agressive and cause cause soft tissue damage
Hello. Wire provides more precision position of the screw, preliminary fixation of bone fragments. Majority of compressive scerws are cannulated. I mean not lag screw but Gerbert screw. My choice is cannulated ones.
Cannulated screws. Interesting question
Decreased trauma. I do not agree that they cause less trauma and subsequently complications. They, if not used correctly, can have increased complication rate ( for example due to lack of proper dissection).
Quick surgery. This can be achieved even with the traditional screws in capable hands.
Potential benefit maybe the use of the soft tissues as part of the way to reduce fragments (ligamentotaxis for example) as there is the risk that with open reduction these soft tissues may be violated. Extensive dissection also can devascularise fragments. Also in case that a separate stabilising wire is used, it is the norm that the position used corresponds at the area that the screw has to be placed. This may be a problem to the novice.
Question then: Can we do the same with non cannulated screws?
Answer. Yes, as this was done in the past frequently and without the use of the wires. Needs more experience.
So the true answer is convenience (for the younger surgeons) and fashion (as a lot of things in our profession).
Correctly using cannulated screw is very important in application for fixation of corrective osteotomies in children and adults.
Guide wire inserted helps in maintaining anatomic alignment while the screw is inserted.
Screws compress the fragments providing stability across the osteotomy.
This technique minimize disruption of soft tissue and vascular blood flow.
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