Getting Better Screw Purchase in Osteoporotic Bone

追加: 2026-05-26

[00:00:00]Well, friends, the model you are seeing here is of distal femur in a healthy subject. There is a dense network of trabeculae. The trabeculae are lying everywhere and we see good volume of bone inside them. So, whenever the patient suffers fractures, we place screws inside this network of bones and that screw pullout strength is going to be good. But, what if the patient has osteoporosis? So, the bony arrangement or the trabecular arrangement is somewhat like this. The trabeculae are sparse and and are not as dense as in healthy bone. So, when you are placing a screw inside this bone, the pullout strength is going to be compromised. And while you want a track like this when you are drilling, you ultimately end up in creating a track like this because of the soft yielding bone and sometimes because of the movements of the drill bit and the bone which is soft here is easily damaged.

[00:00:55]So, ultimately what happens when you place the plate, you get a hole like this. The terminal or the far side of the bone is actually hollow and the pullout strength of the screw is going to be compromised. So, in these cases what we try to do, to save the bone, we just simply create a pilot hole with the locking drill bit and the remaining part of the bone we don't drill. We simply use a blunt ended K-wire. So, we use around 2.8 mm or 2.5 mm K-wires and then we try to push the wires bluntly towards the far side.

[00:01:30]And by that we are not removing any bone, we are not drilling the bone. And ultimately, when it goes like this, you get a track like this. So, the bone is not actually drilled, it's actually impacted in the track that we want. So, this impacted bone is actually dense and when we place the screw, the screw will get a track like this and it will be having superior bone purchase compared to a drill track. While in healthy subjects, we want a good spacious track for placement of screw. In case of osteoporotic patients, the track is already weak. So, if we place screw in already weakened track, we'll have tendency to damage bone more.

[00:02:13]And if we have placed guidewire, it will not remove the bone, rather it will impact the bone. So, by that we'll be able to have a good or superior bone purchase with the screw. And we have been using this trick in proximal humerus, distal radius, everywhere in case of osteoporotic patients. If you want to share some insight, you can simply add those in comments. If you have any other suggestions in management of osteoporotic fractures with some special tips, you can suggest them in the comments. That will be really appreciated. Thanks a lot for watching.