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Stripped screws:  When you strip a screw here are your options:

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Redirect (different direction) the screw so that at least the far cortex gives you a new bite.

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Put in a larger screw (if using a cortical screw, go to a cancellous).

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Put a nut on the other end of the screw. These are available from Synthes for the 4.5mm screws.

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Take out the screws that are stripped, numbering them so you know which one goes where. Mix a half batch of cement (I recommend with some tobramycin in it to reduce your risk of infection LED) and pour it into a 10cc “non-Luer lock” syringe while very liquid, injecting it into the screw holes. Quickly put your screws back in before it hardens, but do not tighten until the cement sets up.

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Choosing a drill bit: Know the manufacturer’s recommended size! However, if you don’t, drill bits should generally be slightly larger than the root (base of the thread) diameter of the screw they are used to drill for.  Thus, if you do not have access to the manufacturer’s recommended drill size, you can choose a drill bit which (Hold them up to the light with the drill bit behind the screw.) extends slightly beyond the root diameter of the screw.  

Removal of broken screws and devices: This can be very difficult, but a useful trick can be to keep a set of “EZ outs” and tool steel drill bits in your locker.  These are relatively inexpensive and can be obtained at an auto parts store.  In desperate situations, you can have them autoclaved (they won’t tolerate this many times because they are not stainless).  You use the tool steel bit to drill a hole in the back end of the incarcerated implant and then screw the “EZ out” into the hole.  “EZ outs” have a left handed conical thread which will eventually become too tight to turn and will then begin to unscrew right handed screws or bolts, or at least give you a point of fixation for pulling out nonscrew type implants.  With stuck hip screws (implanted at St. Elsewhere and for which you do not have the proper extraction “T” wrench) the “EZ out” will screw into the hole for the compression screw and allow you to screw them out.

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