Q. What made you decide to use headless screws over a four-corner fusion plate for a four-corner fusion? A. I used different four-corner fusion plates for several years and was never completely satisfied with the results, especially with the nonunions. I also did not like the large amount of dorsal reaming required to make the concave recess necessary for placement of the plate. With the excellent compression provided by Headless Compression Screws, their ease of placement and their completely buried locations within the carpal bones, I quickly made the transition to using them for intercarpal fusions, including four-corner fusions. I have been very pleased with the results. Nonunions have become very rare in my experience with these screws and even when they do occur, they are often times not painful due to the rigid fixation provided by the screws.
Q. What is your preferred placement for these screws?
A. For four-corner fusions, my preferred placement is as follows: one retrograde 3.5 mm screw across the capitolunate joint (with a starting point at the dorsal base of the third metacarpal), one ulnar-volar to radial-dorsal 3.5 screw across the lunotriquetral joint and one ulnar-dorsal to radial-volar 3.5 mm screw across the triquetrum-hamate-capitate joints. An alternative construct is using four screws, one for each of the intercarpal joints, but I’ve found that three screws do just as well.
Q. Are there any advantages with the new Compression FT Screws over screws that you were previously using?A. The Compression FT Screws provide excellent compression and fixation, similar to other Headless Compression Screws that I was using before. One advantage I saw immediately when using the screw for the first time was that the guidewire did not become stuck and routinely come out with the cannulated drill bit after drilling. This saves time and money. I did not have to fiddle with trying to find the drill hole with a new guidewire and I did not have to ask for a new drill bit for the next screw. Another advantage is the star-drive design of the screw head, which allows for increased torque with the screwdriver and less risk of stripping. The straight outer diameter, or nonconical shape of the screw, is another advantage. If you end up undersizing or oversizing the length of the screw, you can insert the same diameter screw with a different length and still get excellent compression and fixation. The straight diameter drill bit means that you’re not obligated to leave the screw in or go to a larger diameter screw.
Q. How have your results been after your first few cases?
A. My results after my first few cases using the Compression FT Screws for four-corner fusions have been great. No nonunions, no loose screws, and very satisfied patients!
Q. What is your post-op protocol for this case?
A. Due to the excellent compression and fixation with these screws, I allow gentle active range of motion (ROM) (no passive) after the first postoperative visit (7-10 days after surgery). I give the patient a wrist orthosis they can remove for bathing and exercises. I allow passive ROM and strengthening once I see evidence of bony union on radiographs or CT scan, around 6-8 weeks postoperatively.
Q. What are some other indications for which you would use Headless Compression Screws?
A. I use Headless Compression Screws for a number of other indications in the hand and wrist, including scaphoid fractures, radial styloid fractures, large ulnar styloid fractures (with DRUJ instability), other intercarpal fusions, and thumb and finger fusions. Specifically with the Compression FT Screws, I’ve used them across the scapholunate (SL) joint for chronic SL ligament tears (without arthrosis) and lunate dislocations (one across the SL joint and one across the LT joint).