From the Research
The operative procedure for removal of cannulated compression (CC) screws from a femur neck fracture involves several key steps, prioritizing meticulous technique to avoid complications such as fracture, neurovascular injury, or infection, as supported by recent studies 1, 2.
Overview of the Procedure
The procedure begins with the patient positioned supine on a fracture table under general or spinal anesthesia, with the affected hip slightly elevated using a bump. After sterile preparation and draping, the previous surgical incision is reopened through the lateral approach to the proximal femur.
Key Steps in the Procedure
- Fluoroscopy is used to confirm the location of the CC screws.
- The surgeon then identifies and exposes the lateral ends of the screws by careful dissection through the soft tissues.
- Using the appropriate screwdriver that matches the screw head design, each screw is engaged and rotated counterclockwise until completely loosened.
- If there is significant bony ingrowth or cross-threading, gentle tapping on the screwdriver or specialized extraction tools may be necessary.
- The screws are removed sequentially, with care taken to avoid applying excessive force that could cause femoral fracture.
Post-Removal Care
After all screws are removed, the screw tracks are irrigated with normal saline to remove any debris. The wound is then thoroughly irrigated and closed in layers using absorbable sutures for deep tissues and either staples or non-absorbable sutures for skin closure. A sterile dressing is applied.
Post-Operative Considerations
Post-operatively, weight-bearing restrictions depend on the healing status of the original fracture and the reason for hardware removal. Prophylactic antibiotics are typically administered before incision and may be continued for 24 hours postoperatively to prevent infection, as indicated by general principles of orthopedic surgery 3.
Evidence Supporting the Procedure
Recent studies, such as those comparing different screw types for femoral neck fractures 4, 2, and evaluating the outcomes of various fixation methods 1, support the importance of careful technique and appropriate screw selection in minimizing complications and improving patient outcomes. The use of double fluoroscopy, as discussed in 5, can also enhance the precision of screw placement and removal, potentially reducing radiation exposure and improving surgical efficiency.