BIOMECHANICS OF COMMON

IMPLANTS
OUTLINE

 LAG SCREW CONCEPT

 TENSION BAND PRINCIPLE
LAG SCREW CONCEPT

 Aim – to achieve compression across fracture

 2 types
 Cortical screw through gliding hole
 Cancellous bone screw
LAG SCREW CONCEPT

 Prerequisites:

Screw must be
placed
perpendicular
to fracture site
LAG SCREW CONCEPT

 Prerequisites:

NOT in comminuted With cortical screws,

fractures requires over drilling
 LAG SCREW CONCEPT
 Cortical screw through gliding hole:

Drill near cortex with drill Drill far cortex with drill
bit = outer screw diameter bit = inner screw diameter
LAG SCREW CONCEPT
 Cortical screw through gliding hole:

To create a platform on the

Countersink for what? near cortex for the screw
head – ensures full contact
LAG SCREW CONCEPT
 Cortical screw through gliding hole:

Improper countersink – eccentric loading when

compress, might displace #
LAG SCREW CONCEPT
 Cortical screw through gliding hole:

If countersink too deep – remove almost all cortical

bone on near cortex, screw may break through and end
up in medullary canal
 LAG SCREW CONCEPT
 Cortical screw through gliding hole:

Tap the far cortex, must push Final screw placement

it thru the near cortex – will
form false track
 LAG SCREW CONCEPT
 Cancellous bone screw:

Drill near cortex with 3.2mm Measure and tap with

drill bit for 6.5 screw, do not 6.5mm cancellous bone
perforate far cortex tap
LAG SCREW CONCEPT
 Cancellous bone screw:

Place screw, being cancellous bone, doesn’t require gliding

hole and countersink, but requires washer as cortex is thin
TENSION BAND PRINCIPLE
 Concept introduced by Pauwels (an engineer)

An eccentrically loaded bone will always

have a tension side and compression side
TENSION BAND PRINCIPLE

A tension band converts a tension force into a

compressive force across the whole width of bone
 TENSION BAND PRINCIPLE

Even when put on tension side, an intact buttress still

needed in compression side for the tension band to work
TENSION BAND PRINCIPLE

Dynamic tension band – produces increased

compression with motion
TENSION BAND PRINCIPLE

Static tension band – already producing compression

at moment of reduction – remains constant
TENSION BAND PRINCIPLE

Placement of wires ideally 5mm deep to the anterior

surface, will be close to joint– but will not impair
tension band principle if not.
 TENSION BAND PRINCIPLE

 Which one?

More stable against Less likely to cut thru the

torsional forces medial and lateral retinacula
TENSION BAND PRINCIPLE

 What causes this?

How to prevent it?

TENSION BAND PRINCIPLE

Know any other

techniques?