Open Reduction Surgery: Removing Broken Hardware

Mason Type III fractures are a type of radial head fracture, which commonly occur during elbow traumas. Radial head fractures account for 4% of all fractures and 33% of elbow fractures. The treatment of Mason Type III fractures is a controversial topic, with open reduction and internal fixation (ORIF) and radial head excision being the two main methods.

The use of ORIF in treating Mason Type III fractures has been supported by studies that have shown it to result in better long-term outcomes compared to radial head excision. These studies have found that ORIF leads to improved elbow joint stability, grip strength, and reduced frequency of elbow pain.

However, ORIF is a technically demanding procedure and can be associated with complications such as early failure, nonunion, joint dysfunction, and metaphyseal bone loss. On the other hand, radial head excision has been linked to complications such as longitudinal radial migration, radio-ulnar convergence, elbow joint instability, and reduced grip strength.

As a result, the choice between ORIF and radial head excision for the treatment of Mason Type III fractures remains a subject of debate among medical professionals.

Open reduction and internal fixation vs. radial head excision

Open reduction and internal fixation (ORIF) and radial head excision are two surgical treatment options for Mason type III radial head fractures. Radial head fractures are common and account for one-third of elbow fractures. The radial head is crucial to elbow and forearm stability and contributes to forearm rotation.

Radial head excision involves the removal of the radial head, which can lead to instability, restricted motion, and distal radio-ulnar joint dysfunction. This procedure was historically the primary treatment for displaced comminuted radial head fractures but has fallen out of favour due to its high complication rate.

ORIF, on the other hand, is a more complex procedure that involves surgically fixing the fractured radial head. This method has been associated with complications such as early failure, nonunion, joint dysfunction, and metaphyseal bone loss. However, it has also been reported to have a high success rate in treating radial head fractures.

The choice between ORIF and radial head excision depends on various factors, including the severity of the fracture, associated injuries, and patient characteristics. Some studies suggest that ORIF leads to better outcomes in terms of elbow joint stability, grip strength, pain reduction, and range of motion. Other studies, however, indicate that arthroplasty, which involves replacing the radial head with a prosthesis, may result in better functional elbow outcomes and lower complication rates compared to ORIF.

Overall, the decision between ORIF and radial head excision should be made on a case-by-case basis, considering the specific circumstances of each patient and the expertise of the treating surgeon.

Radial head arthroplasty

The radial head is an important structure that contributes to elbow and forearm stability, as well as forearm rotation. Radial head fractures typically occur after a fall onto an outstretched hand and account for about one-third of all elbow fractures.

The treatment of radial head fractures has evolved over the years, and while there is no standardized treatment protocol due to the complexity of these fractures, radial head arthroplasty has emerged as a popular option. This procedure involves replacing the radial head with a metal prosthesis.

Several studies have compared the outcomes of radial head arthroplasty with ORIF for Mason type III radial head fractures. Some studies have found that arthroplasty results in better functional elbow outcomes and lower complication rates compared to ORIF. However, there is a scarcity of high-quality comparative studies, and more research is needed to establish definitive conclusions.

The success of radial head arthroplasty has been reported in patients with both stable and unstable fractures. Radial head arthroplasty has been found to be effective in treating unstable elbow injuries, with recovery of functional elbow range of motion and no difference in complication rates or implant longevity compared to stable injuries.

The choice between radial head arthroplasty and ORIF depends on various factors, including the severity of the fracture, associated elbow instability, and patient factors such as age and activity level.

Screw removal with a stripped head

Removing a stripped screw can be a frustrating experience, but there are several methods you can try to get the screw out. Here are some detailed, direct, and instructive steps to remove a screw with a stripped head:

• Try a different screwdriver: If you're using a Phillips-head screwdriver, switch to a flat-head screwdriver, or vice versa. You can also try using a smaller or larger size screwdriver in the slot.
• Use a screwdriver and hammer: If the screw is made of a soft metal, you can create a new slot by sticking a flat-head screwdriver into the screw and gently tapping it with a hammer. Then, twist the screwdriver to remove the screw.
• Use pliers: If enough of the screw is exposed above the surface, you can try using pliers to get a firm grip on the screw and twist it out. Locking pliers or vise grip pliers work best.
• Use a rubber band: Place a rubber band over the head of the screw and insert your screwdriver into the rubber band. This will help increase friction and allow you to turn the screw counterclockwise to remove it. You can also use steel wool or abrasive powder instead of a rubber band.
• Drill into the screw: Use a drill bit designed for metal and drill a small hole into the head of the screw. Be careful not to drill too far, as the head could come off.
• Use a left-handed drill bit: Left-handed drill bits are designed in the opposite direction of regular drill bits and can help remove stripped screws. Set your drill to reverse mode and drill into the head of the screw.
• Cut a slit into the screw: Use a rotary tool or a hacksaw to carefully cut a slit into the head of the screw, making sure the slit is large enough to fit a flat-head screwdriver. Then, twist the screwdriver to remove the screw.
• Use anti-cam out fluid: Applying anti-cam out fluid to the head of the screw can increase friction and make it easier to remove.
• Try a larger screwdriver: If the screw is not too badly stripped, a larger screwdriver may fit into the head and allow you to rotate it out.
• Use a flat-head screwdriver: If you're having trouble with a Phillips-head screw, try using a flat-head screwdriver in combination with a friction-enhancing material like a rubber band.
• Glue or weld a nut to the screw: If you have a nut, try gluing or welding it to the head of the screw. Once it's secure, use a socket wrench or spanner to loosen the screw.
• Use a screw extractor: Choose a screw extractor that fits your screw, and follow the instructions for creating a smooth hole in the screw head and then drilling it out.
• Connect the screw to a drill: If the screw head is exposed, place the drill chuck over the head, tighten the jaws, put the drill in reverse, and gently rotate the screw out.
• Loosen the screw: Apply penetrating oil or heat to the area to help loosen the screw. Then, insert your screwdriver and twist.

Screw removal with a broken head

Removing a screw with a broken head can be challenging, but it is possible. Here are some methods to achieve this:

• Using locking pliers: If the broken screw head is still protruding from the surface, you can try grasping it with locking pliers and slowly turning it counterclockwise until it is free. This method requires a gentle touch to avoid snapping off the remaining portion of the screw.
• Drilling a pilot hole: If the screw has broken at the wood surface, you can use a utility knife to carefully cut away some of the wood around the screw shank. This will expose more of the shank, allowing you to grasp it with locking pliers and back it out. Afterward, drill a hole at the screw location and fill it with a dowel or plug for a seamless repair.
• Drilling and tapping: If the screw has broken off below the surface, you can use a drill bit to widen the screw hole down to the broken end. Then, use a nail and hammer to create some starter holes around the screw. Next, use a smaller drill bit to bore holes beside the broken screw on all sides, drilling at least as deep as the screw length. Finally, use an awl or nail punch to wiggle the screw loose, and then grip it with needle-nose pliers to pull it out.
• Screw extractor: If the broken screw head is still above the surface, you can use a screw extractor to remove it. First, drill a small hole in the center of the screw head, and then place the extractor tip into the hole. Slowly turn the extractor counterclockwise while applying gentle pressure until it bites into the screw head. Continue turning the extractor to back the screw out enough to grip it with locking pliers and finish removing it.
• Drill bits: Another method is to use a left-hand drill bit. Start with a small bit and gradually work your way up in size, trying to catch the broken screw and pull it out.
• Epoxy and screwdriver: You can also try using epoxy to attach a screwdriver to the broken portion of the screw. This will allow you to unscrew it as you would a regular screw.

Screw removal with a stripped head using a rubber band

Removing a screw with a stripped head can be a frustrating experience. However, a rubber band can be used to grip the stripped screw head and allow you to extract the screw. Here is a step-by-step guide on how to do it:

• Choose a rubber band that is wider than the screw head. It needs to cover the opening in the screw head, so get a single, thick rubber band.
• Position the rubber band over the stripped screw head. Press part of the rubber band flat against the screw head and hold it firmly in place with one hand.
• Push the screwdriver into the rubber band and screw head. Make sure the rubber band goes inside the opening on the screw head and moulds with the screw threads.
• Turn the screwdriver counterclockwise to remove the screw. Work slowly and maintain firm pressure on the rubber band. You should feel the screw begin to turn and come loose.

If the rubber band method is not working, there are a few other techniques you can try:

• Use a screwdriver and hammer: Place the rubber band over the screw, followed by the screwdriver. Tap the back end of the screwdriver a few times with a hammer to wedge it in place and get a better grip on the screw threads.
• Drill through the screw: Use a power drill with a 1/8-inch drill bit designed for metal. Drill straight down into the centre of the screw head, then try removing the screw with a screwdriver and rubber band.
• Cut into the screw with a rotary tool: Use an oscillating tool, such as a Dremel, with a metal-cutting disk attached. Deepen the screwdriver slot in the screw head, then insert the rubber band and screwdriver to try and remove the screw.

Frequently asked questions