Screws are the most common general

purpose fixation devices. They may be the

only hardware used in reparative or
reconstruction surgery. More commonly,
however, they are used with other hardware
devices, particularly plates, to fixate the
associated device to bone. For fractures that
have large well-defined components, screws
are used both to fixate plates and as
standalone devices to fixate the fracture
fragments.

Cortical screw

Is used particularly for hard bone tissue,

such as shaft of long bones.

Cancellous Screw

Is specifically made for spongy bones

present at the ends.

Pedicle Screw

These are used by orthopedists for spine

fusion or fractures.

Cannulated Screw

These are used to pass a guide wire

through it for perfect placement of the
screw.
the femoral neck and intertrochanteric region.
Herbert Screw

Is designed for internal fixation of broken

bones that includes the joint cartilage. The
major feature of these screws is that they
are headless, so even after the settlement
of the screw; the joint movements are not
clogged by a screw head.

Malleolar Screw

for the fixation of ankle fractures.

Dynamic Hip Screw

Are used for internal fixation of fractures Plates
of Plates are some of the most common general
purpose fixation devices. They contain holes for
Dynamic Hip Screw screws and pins that are used to fix the plate to
intact bone and to fractures.
are used for internal fixation of fractures
of the femoral neck and intertrochanteric
region. The screw is a large cancellous lag
screw that glide freely in a metal sleeve.
The sleeve is attached to a side plate that
is fixed to the lateral femoral cortex with
screws. Weight bearing cause the femoral
head to becomes impacted on the femoral
neck producing dynamic compression of
the fracture. The shaft of the lag screw
slides down the sleeve maintaining
reduction of the fracture as compression
occurs.
Pins and Wires
Pins and wires can be used as standalone
orthopedic hardware or as components
of larger hardware constructs. When used
for internal fixation, they provide in
general much less resistance to external
forces than plates, nails, or rods.
Therefore, when used alone, they are
used for bones which normally
experience relatively weak external
forces. These devices are used as
standalone devices in the upper
extremities and as adjunctive hardware in
the lower extremities along with
hardware that can withstand the larger
axial loading forces. Pins used for external
fixation are described in an accompanying
sections. These pins are thicker and are
designed to support greater loads.
Kirschner wires, or K-wires, are small
diameter rods that are rather easily bent.
They are small enough to be used for
across the joint fixation without
significant damage to articular cartilage.
They are frequently used for fracture
fixation of the hands and feet and as
guide wires for placement of cannulated
screws
Kirschner wires have many uses. They can be used
as the primary fixation device for fractures in the
hands and feet. They can also be used as adjunctive
fixation devices for complex fractures of larger
bones. The x-ray on the right shows a bimalleolar
fracture. The medial malleolus is fixated with a
plate with screws and by two K-wires. There is a
Rush rod in the fibula.
Cables are used primarily as adjunctive fixation
devices for fractures of the long bones. Their use is
illustrated in the x-ray at the right. The cables
around the proximal femur provide compression to
the bone and help improve contact with the
femoral prosthesis. This prosthesis is a non-
cemented, bone ingrowth type and the
compression improves bone ingrowth.
Tension band wiring of a patellar fracture, lateral
and AP views of the knee. The tension band wire
has a characteristic figure of eight appearance and
has been reinforced with K-wires. Note on the
Intramedullary Rods and Nails lateral view that the wires are placed anteriorly.

Intramedullary rods and nails are means of

fracture fixation in which a long metallic
implant is inserted at one end of a long
bone through the medullary canal. The
nail itself may traverse  a fracture or the
nail may be used as a rigid support for
screws, pins, or other nails that fixate a
fracture.

Rods are simple solid cylinders that are

thinner and more flexible than nails. They
are not fixated with screws or pins.

Nails are more rigid implants that usually

have proximal and distal holes for the
insertion of locking (interlocking) screws
and pins that fixate the implant to bone.
 Antibiotic Rod

Treatment of infections of intramedullary rods is

difficult. The rod must be removed, but standard
intravenous antibiotic treatment cannot deliver
high concentrations of antibiotics to the affected
bone. One method of accomplishing such delivery
is with an antibiotic rod.

Intramedullary tibial nail inserted in a static

configuration with proximal and distal locking
screws

Anchors

Suture anchors (also called soft tissue anchors) are

small devices placed in bone that have attached
sutures or other materials that can be used for
repair of soft tissues structures. They are most
commonly used in the shoulder and knee regions
for reattaching ligaments and tendons.

Typical tibial nails with proximal and

distal transverse holes for locking pins.
 CLASSIFICATION OF JOINT REPLACEMENT

1. Metal
2. Polymer
3. Composite
4. Ceramic
5. Cement or non-cemented.

HIP REPLACEMENT PROSTHESES

Suture anchors in the left humeral head

for rotator cuff repair.

JOINT REPLACEMENT HARDWARE

A joint replacement can be classified as a

total joint arthroplasty, a hemi-
arthroplasty, or a resurfacing technique.

 A prosthesis replacing one side of a joint

can be a single piece (monoblock) or
modular in which the prosthesis has
interchangeable parts. The prosthesis in a
hemiarthoplasty can have a unipolar or
bipolar design. This is especially common
with femoral head prostheses. 

A unipolar prosthesis articulates with the

nonreplaced native joint surface. In a
bipolar design, the prosthesis has an
additional across the joint component with
which it articulates, but this component
does not replace the joint surface.

The FDA classifies joint prostheses by the

degree to which normal joint motion is
restricted. An implant that is free to move
in all planes is referred to as an Modular metal head
unconstrained prosthesis. An implant  that Collar on stem
allows free motion in one plane and  Cemented
limits, but does not prevent,  motion is the
other planes is referred to as
semiconstrained. A constrained prosthesis Modular metal head
allows motion in only one plane and no Roughened hydroxyapatite
motion in other planes. Constrained coated upper stem
prostheses have flexible, across the joint, Noncemented
linking components.
Modular metal head
Acetabular prostheses can consist of one Smooth metal stem
of or more components which may be Cemented
modular in design. The most common
prostheses are the polyethylene types
Modular ceramic head
which are radiolucent and cemented and
Hydroxyapatite coated
the polyethylene liner with a metal cap
proximal stem
which is noncemented but may be affixed
to the acetabulum with screws. Noncemented

Modular designs for the femoral

prosthesis most commonly involve
interchangeable heads, but some designs UNCEMENTED TOTAL HIP ARTHROPLASTY
include interchangeable necks and distal
portions of the stems.

Both femoral and acetabular components

may have porous or nonporous surfaces.
The latter surface is roughened and
uncemented allowing bone ingrowth.
Nonporous surfaces may be coated with
hydroxyapatite to enhance bone ingrowth.

Total hip arthroplasty (Howmedica).

Acetabular component has a
hydroxyapatite coated metalic outer shell
and a modular ceramic liner. The femoral
component has a modular ceramic head
and a hydroxyapatite coated proximal
stem.

Uncemented total hip arthroplasty. Note

tight fit between distal stem and cortex.
This is an example of a press fit. The
proximal stem is roughened to encourage
bone ingrowth.
CEMENTED UNIPOLAR HIP
HEMIARTHROPLASTY

Femoral prosthesis, unipolar cemented.

Cemented unipolar hip hemiarthroplasty.

BIPOLAR HIP ARTHROPLASTY

Acetabular components of bipolar hip
hemiarthroplasty. The upper image shows how the
polyethylene shell that the head fits in rotates
freely in the shell. The lower image shows how the
head is captured by the liner unlike a total hip
arthroplasty in which the head can be easily
dislocated. The outer shell can rotate in the
acetabulum and is not fixed in the acetabulum as
with a total hip arthroplasty.

Cemented bipolar hip hemiarthroplasty. Note that

the neck of the femoral stem passes into
acetabular component and that there appears to
be ring below the level of the head. This represents
the head fitting into and being constrained by the
acetabular component.
 Right total knee arthroplasty, cemented, posterior
cruciate ligament sparing type, AP view.
KNEE REPLACEMENT

There are three components to knee

replacements: the femoral, tibial, and
patellar components. The femoral
component is usually all metal. It
articulates with the tibial and patellar
components. The tibial component
consists of a polyethylene tray that is
radiolucent and is responsible for the
radiographic joint space and a tibial stem
that is usually metal. The patellar
component is polyethylene but may have a UNIPOLAR HUMERAL SHOULDER PROSTHESIS
metal backing. The components may be
cemented or uncemented.

One of the important considerations in

total knee replacements is whether the
posterior cruciate ligament is spared or
substituted. The posterior cruciate
ligament is important for knee stability,
and operations in which the ligament is
sacrificed require a prosthetic posterior
stabilizing construct. This construct is a
post that attaches to the tibial tray and
articulates with a "box" on the femoral
component that is visible radiographically.
 Total elbow arthroplasty. There is severe loosening
of the humeral stem with bone loss.

Total elbow prosthesis.

SPINAL HARDWARE

Hardware for the spine differs from other types of

orthopedic hardware because of the unique
anatomy and function of the spine. For example,
spinal fixation for fractures or instability usually
requires bone grafting. Hardware also differs
between the cervical, thoracic, and lumbar spines.
Techniques also differ. While the lumbar and
cervical spines can be approached anteriorly or
posteriorly, the thoracic spine is approached
posteriorly. Surgery for spinal stabilization requires
Right shoulder unipolar humeral
bone grafting. A diskectomy is performed and
hemiarthroplasty, cemented.
fusion is obtained by varying methods. Bone grafts
can consist of morcelized bone, bone allograft, or
Prosthesis in x-ray is Biomet Bio-modular
humeral stem. metal cages. Newer methods involve bioresorbable
materials and bone growth factors.
TOTAL ELBOW REPLACEMENT

Cervical plate with screws.

 Hardware reconstruction of implant on left.
There are two rods connected by three
crosslinks. On each side, there are two pairs
of hooks and claws. The hooks are above the
claws, facing inferiorly. The hooks engage a
transverse process or a lamina. At the next
inferior vertebral level, there is a pedicle claw
facing upward that contacts the inferior
surface of the pedicle.

Upper thoracic spinal fixation with bilateral rods,

pedicles screws, hooks, claws, and crosslinks

LUMBAR SPINE RODS AND SCREWS

Lateral view. Anterior cervical plate.

Vertebroplasty C4 and C5 with placement
of vertical bone allograft. Plate has screws
that insert into C3, the allograft, and C7.

THORACIC RODS AND SCREWS