ORIF - Lag screw fixation

In this procedure the main goal is to reconstruct the joint surface.

For this procedure the following screws are typically used:

• Conventional 3.5 lag screws
• Cannulated 3.5 lag screws
• Headless 3.0 screws

Headless screws are preferable where fixation involves inserting them through capsule or labrum.

If a headless screw is used, bicortical purchase is preferred but not required for compression.

This procedure may be performed with the patient in either a beach chair position or supine position.

Anterior fractures are reduced and fixed through the deltopectoral approach.

Reduction of the articular surface may be facilitated by the insertion of a K-wire to be used as joystick. For this reason we prefer to use the cannulated system and insert the K-wire in such a way that it will subsequently serve as a guide for the lag screw trajectory.

Whenever K-wires are used as joysticks, whether as subsequent guide wires or not, they should not be inserted trans articulary.

When conventional screws are used for the fixation, care must be taken that the K-wire does not interfere with the planned screw placement.

When reduction is completed, the K-wire is further inserted to temporarily fix the fracture.

Make sure that K-wires are not directed into the suprascapular notch where they can compromise the neurovascular bundle.

Depending on the size of the fragment, two lag screws are preferred since one does not offer rotational stability.

The K-wires are removed.

Check the position of the screws and the reduction by image intensification in the standard projections (trans-glenoid and trans scapular view). A 3D-CT scan, if available, is very useful to verify the position of the fixation devices.

The aftercare can be divided into 4 phases:

1. Inflammatory phase (week 1–3)
2. Early repair phase (week 4–6)
3. Late repair and early tissue remodeling phase (week 7–12)
4. Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.