Modified orthopedic wire twister for fixing and removing screws in craniomaxillofacial osteosynthesis

Abstract

Internal fixation is the routinely performed surgical procedure in craniomaxillofacial surgery. At present, available kit for internal fixation includes large number of armamentarium. To overcome and reduce this, we have modified orthopedic wire twister for fixing and removing screws. This single device can replace self-holding screwdrivers with different sizes.

INTRODUCTION

Internal fixation is one of the most commonly performed procedures for management of craniofacial fractures and orthognathic surgery. Screws are the basic element for the fixation of plates or similar devices onto bone or as lag screws to hold fractured fragments together. Due to various thickness of bone in craniofacial region, the screws used are between 1.0 and 2.7 mm in size, which varies in diameters, designs, and length.[1] Existing osteosynthesis system for bone plating requires two types of screwdrivers, those which are self-holding screwdrivers and the other conventional screwdrivers to enable final tightening for fixation and initial loosening for removal. It is required that we need screwdrivers of different sizes (1, 1.5, and 2 mm) to fit different sizes of the screws available. In a patient of panfacial fracture, we may need to use all three-size self-holding screwdrivers and hence add to the number of instruments in the armamentarium inventory and also add to the cost of the treatment. In this article, we have modified an existing orthopedic wire twister that can hold all the screws and can act as a single universal screw holder/driver.

TECHNICAL MODIFICATION

It is always necessary to maintain a huge inventory of instruments when we plan internal fixation. In our modification, we have converted a stainless steel, orthopedic wire twister to hold different screws irrespective of the size and shapes of recess [Figure 1]. The beaks of the wire twister have a slot, in which screw head is held firmly and the instrument is locked using the ratchet of the wire twister [Figure 2]. The main advantage of our instrument is that it replaces all the self-holding screwdrivers. It can hold 1.5, 2, 2.5 mm screws. It can also hold screws with heads having different recess pattern, for example, cruciform and hexagonal.[2] Although it replaces self-holding screwdriver, we require screwdrivers designed to adopt the recess of screws for final tightening and initial loosening.

Figure 1.

Schematic diagram showing the modification with a slot in the beaks of wire twister

Figure 2.

Schematic diagram of the modified wire twister holding the screw

CONCLUSION

Our universal screwdriver is simple instrument which can simplify and reduce number of instruments, thereby reduces the cost of internal fixation significantly. It is also very convenient and efficient in holding screws firmly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.