Basic Orthopedic Hardware

Internal Fixation Hardware

1. Screws
2. Plates
3. Pins and Wires
4. Intramedullary rods and nails
5. Anchors

Screws Overview
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.

The main features of a screw are shown to

the right along with the standard names
for its parts. Each of the parts can be
modified to produce screws with specific
characteristics. The most common
variations are differences in spacing
between the threads (pitch), core diameter,
and tip design. Screws can have hollow
(cannulated) or solid central axes and can
be fully or partially threaded. Screws tips
are designed to be tapping or nontapping
(see glossary). Screws are often referred to
by the outer diameter of the threaded
portion, 3.5, 4.5, and 6.5 mm screws being
the most common.
 Upper Extremity Buttress Plates

Medial Distal Humeral Greater Tuberosity Humeral Posterior Ulna/Olecranon

Lateral Distal Humeral Plate
Plate Plate Plate

Tibial Buttress Plates

 Distal Medial Tibial
Proximal Medial Tibial Plate Proximal Lateral Tibial Plate Distal Lateral Tibial Plate
Plate

Lateral Tibial Buttress Plate

Lateral tibial buttress plate: AP and lateral views. Note the L-shape which is
only apparent in the lateral view. Two cancellous screws inserted through the
tibial plateau act as lag screws. Four cortical screws transfix the vertical portion
of the plate to the tibial diaphysis.

Calcaneal Buttress Plate

Calcaneal Buttress Plate: The plate is similar in appearance to a reconstruction
plate. There are several different designs which can be tailored to the fracture
pattern of the calcaneus.

Calcaneal Buttress Plate

 Kirschner (K) Wires

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
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
noncemented, bone
ingrowth type and the
compression improves
bone ingrowth.
Tension Band Wiring
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 lateral view that the wires are placed
anteriorly.
FEMORAL NAIL
Illustration of how a femoral nail is inserted and how the locking pins are
placed. In this example, the nail has been placed in a retrograde fashion.
Typical femoral nail with one proximal and two distal transverse locking
pins. Used primarily for diaphyseal fractures.

PROXIMAL FEMORAL NAIL

Intertrochanteric fracture fixated with a proximal femoral intramedullary nail.
This nail is designed for proximal femoral fractures, especially in the
intertrochanteric region. Nails for proximal fractures must be thicker to
withstand the high stress in the intertrochanteric and subtrochanteric
regions.

LONG PROXIMAL FEMORAL NAIL

Femoral neck and diaphyseal fractures fixated with a long femoral
intramedullary nail and proximal locking lag screw. This nail is designed for
combined fractures of the proximal femur and the diaphysis. Nails for
proximal fractures must be thicker to withstand the high stress in the
intertrochanteric and subtrochanteric regions.
TIBIAL INTRAMEDULLARY NAIL
Pre-op image of proximal diaphyseal fractures of the tibia and fibula.
Intramedullary tibial nail inserted in a static configuration with proximal and distal
locking screws Typical tibial nails with proximal and distal transverse holes for
locking pins.

Antibiotic Rods
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 as
shown on the right. The
infected tibial rod was
removed. A chest tube was
used to contain a slurry of
antibiotics and a biocompatible
material such as
polymethylmethacrylate that
quickly hardens. The material
is placed in a chest tube with a
thin diameter wire. When the
material hardens sufficiency, it
is extracted and inserted into
the tibial medullary space.The
antibiotic leaches from the rod
achieving higher
concentrations than could be
obtained with intravenous
administration.