Periprosthetic Femur Fractures: The Screw-In-Washer Technique for Bicortical Small-Fragment Screw Fixation Through Large-Fragment Plates. A Technical Trick and Case Series.
Ahmed Nageeb Mahmoud, Daniel S Horwitz
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Case in brief
A patient with a periprosthetic femur fracture presented with challenges in achieving stable fixation due to the presence of a medullary-filling femoral stem. The screw-in-washer technique was employed, utilizing bicortical small-fragment screws through large-fragment plates. This approach provided secure fixation and improved stability in the osteoporotic bone, leading to successful outcomes.
Diagnostic / clinical pearl
The screw-in-washer technique offers a reliable method for bicortical screw fixation in periprosthetic femur fractures, particularly in cases with challenging anatomy.
Why it matters
This technique may enhance stability in osteoporotic bone, reducing the reliance on less effective fixation methods like unicortical screws or cerclage wires.