Peter Hull With thanks to LVR March 2012

 Screws  Plates  Nails  External fixators

 Head  Stops screw sinking in bone  Connection to screw driver  ? Locking screw, locks head into plate  Shaft  Core, Partial or fully threaded  Thread  Shape  Depth  Pitch  Tip  Blunt  Self tapping

 Cortical  Cancellous  Partially threaded  Headless  Locking  Fixed angle  Variable angle

 Normal screw  Drill core  Measure  (Tap)  Countersink  Insert screw

 Lag screw  Over drill near cortex Gliding hole  (thread diameter)  Drill core diameter  Measure  (Tap)  Countersink  Insert screw

 Compression screw  Anchor plate  Eccentric drill  Repeat

 Achieve compression via  Variable pitch in the thread  Examples  Herbert screw  Barouk screw  Acutrak / Acutrak 2

 1/3 rd tubular  Reconstruction plate  Dynamic Compression Plate – DCP  Low Contact Dynamic Compression Plate – LCDCP  Locking Compression Plate – LCP  Special plates  Pre contoured, anatomic, injury specific

 Solid  Hollow, cannulated  Reamed  Un reamed  Titanium elastic nails (TENS)  Bending rigidity proportional to diameter 4  Increasing diameter by 10% increases bending rigidity by 50%  Reaming allows increased torsional resistance due to larger contact area and allows larger nail with increased rigidity and strength

 Monolateral frame  Hybrid  Ilizarov frame