Alternative approach for the removal of problem miniscrews--a serendipitous finding.
1 Removal of devices used for osteosynthesis can be difficult t times, particularly when there is a degree of osseointegraion, the wrong kit is used, or the head of the screw has become amaged.1 During one such procedure we were attempting to remove miniplate from the infraorbital margin in a patient having secondary operation after repair abroad. Initial attempts to emove the screws using our “universal screwdriver kit” were ot successful, and eventually damage to the heads of two crews prevented the screwdriver being engaged securely. As an alternative we decided to drill the bone circumferntially, and use a clip to grasp the head – a commonly used, nd a tried and tested technique, although others have been escribed.2 However, unknown to us the drill motor was set in everse and when applied, the Toller fissure burr engaged the rst screw with enough frictional torque to remove it easily Fig. 1). The second screw was removed in a similar way by placing he burr directly over it to maximise grip. It also came out ith relative ease. The technique has now worked on several ccasions and is a conservative way of removing problem
Removal of broken screws using a hollow rubber tube (Nelaton catheter).
mplant removal is controversial, and not without omplications.1 Our policy is that unless the manoeure is difficult and invasive, the screw should be removed o avoid later complications such as dehiscence, infection, nd palpation, sometimes reflecting the patient’s subjective iscomfort often provoked by cold. We also think that it s not until the normal structural dynamics of bone are chieved that the treatment of a fracture ends, because the xation devices in situ will be foreign bodies and potential ources of secondary problems in future. Because of excessive torque during removal, surgeons ften encounter stripping of the head of the screw and breakge at the neck, particularly when long screws have been used r the implant has been in place for some time. We therefore eed a recovery strategy for removal of the retained broken crew. The conventional method involves excavating the bone round the screw with a burr, holding it with pliers, and turnng repeatedly. This, however, does not always recover the crew and often makes it worse, because it wears the thread idge from the screw, sometimes making the axial surface hine as if it were polished. If this happens, the more that the urgeon tries to twist with pliers, the less the frictional force etween the screw and the pliers. We present a new way to emove the retained screw by increasing the frictional force etween the screw and pliers. Instead of using rubber-grip liers we have covered the screw with rubber. A man fractured the symphysis of his mandible in a road raffic crash. It was reduced and fixed using a Lock plate with screws (Compact Lock Mandible, Synthes, Davos, Switzerand), one of which was 11 mm long, and three 13 mm long.
Letting Women in? Gender Mainstreaming in Regional Policies
Gender mainstreaming has over the last ten years become the dominant strategy of integrating gender issues in public policy. This article presents regional policy as a broad and increasingly important policy field to study, and analyses gender mainstreaming in this policy field in the Norwegian and the Swedish contexts. How do problem representations surrounding “gender equality” and “gender mainstreaming” produce meanings of gender as well as construct possibilities for change? The article shows that, despite some differences between the two countries, gender mainstreaming in regional policy can to a large extent be read as meaning “women”. Women are in this context given a narrow subject position and are constructed as lacking what it takes to produce sustainable regional growth. The concluding discussion highlights the relations between the implementation of gender mainstreaming and neo‐liberal political trends.