Osteosynthesis is the surgical treatment of bone fractures to restore full function.
The basic principles of osteosynthesis are:
1. Restore the anatomy (reduction of fragments);
2. Establish stability (internal fixation with implants);
3. Preserve blood supply;
4. Early mobilization of the limb and patient.
Plates and screws are the most used implants in the osteosynthesis.
A screw is a mechanical device that converts rotation into linear movement, as you rotate the screw clockwise the tip of the screw advances.
Screws are used alone or with a plate and they can be classified according to:
· Size (the size usually refers to the thread diameter);
· Design (locking head, conventional, cannulated screw, etc.);
· Function (Lag screw, plate screw, position screw);
· Characteristics (self-tapping, self-drilling, etc.);
· Application site (cortical, cancellous, bicortical).
But these terms are sometimes mixed, for example, a screw might be referred to as a 4.5mm self-tapping cortex screw.
A standard bone screw consists of head, core, thread and tip.
Plates can be classified according to:
· Design (third tubular plate, DCP-dynamic compression plate-; LCDCP-low contact dynamic compression plate-; LCP-locking compression plate-);
· Function (Compression, Protection (also called neutralization), buttress, tension band and bridging).
The instruments necessary for the implantation of all these implants (drills, taps, guides, countersink, depth gauge, screwdrivers, etc) must be in perfect condition (sterilized, sharp, etc.).
The scrub nurse has to know instrumentation and the different techniques. Protocols about all of them are useful and training is very important.
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