Saw transection of retained compression screws with damaged heads instead of removal in revision first metatarsal osteotomy: a technique tip

Abstract

Distal first metatarsal osteotomy is performed to correct hallux valgus. The surgery is being performed throughout the UK in increasing numbers. The osteotomies used are commonly fixed with one or two variable pitch compression screws. Recurrence of the deformity or inadequate correction in the primary surgery may require revision osteotomy which necessitates removal of previous screws. Revision rates for scarf osteotomy have been reported at 5%. Removal of screws can be challenging as they are often buried in bone and/or the screw heads can get damaged even despite meticulous preparation. Various techniques for removal of damaged screws are described, which require additional equipment and may result in significant loss of the host bone. We describe another technique where a standard Stryker TPS sagittal saw and saw blade (Kalamazoo, USA) are used to cut through the shaft of the compression screws in line with the planned revision osteotomy. We have successfully performed this on two occasions with good results, and describe our experience of using this technique which eliminates the need for complex over drilling procedures often required for removing stripped and retained screws