Acutrak 3 Headless Compression Screw System

Product Overview

Acutrak 3 is the latest innovation in our headless compression screw technology and is comprised of 93 unique screws that include the introduction of a new 2.0mm diameter Nano screw and extensions to the existing lengths of the Micro, Mini, and Standard screws, allowing expansion on the many indications historically treated with the Acutrak 2 system.

Instrumentation

Additionally, Acutrak 3 has redesigned the instrumentation with a focus on ease of use for surgeons: all screws measure from the tail/back of a guide wire, the new screw sizer allows for implant measurements at unique angles, the drivers have a new hexalobe interface, and a parallel guide wire has been added for stability or secondary implants between 2.5 mm - 20 mm in distance.

Key Publications

This collection of published literature represents clinical evidence, which along with innovation, education, and quality form Acumed’s foundations of excellence. In addition to citing existing scholarly papers, we conduct ongoing clinical research and use this information for validation and continuous improvement to deliver the greatest value to our customers.

Lateral Fixation of AO Type-B2 Ankle Fractures: the Acutrak Plus Compression Screw Technique

Publication Excerpt

“Lateral fixation of AO type-B2 ankle fractures by the APCS (Acutrak Plus compression screw) is a safe and effective technique. It offers several advantages including stable fixation, a small surgical wound, less dissection of soft tissue, a headless device without palpable hardware, and easy applications with a short operating time.”

Journal Abstract

The Acutrak plus compression screw (APCS) (Acumed Inc., Beaverton, OR, USA) is an intramedullary implant which can achieve stable fixation with minimum soft tissue dissection. The characteristics of the APCS include fully-threaded length, headless, cannulated, and variable thread pitch. Twenty-three patients with AO type- B2 ankle fractures treated with lateral fixation by an APCS were retrospectively reviewed. Evaluation of postoperative roentgenograms for adequacy of reduction revealed a good reduction in 22 of 23 (95.7%) patients. The average wound incision was 4.1 cm. The operative time was 25.3 minutes. All the ankle fractures showed radiographic evidence of healing within four months. At the final follow-up, the ankle scores of the patients were evaluated for functional outcomes. Good to excellent results were obtained in 21 (91.3%) patients. No patient complained of symptomatic hardware. In conclusion, lateral fixation of AO type-B2 ankle fractures by APCS offers several advantages including stable fixation, a small surgical wound, less dissection of soft tissue, no palpable hardware, and easy application with a short operating time.

Reference

Chen SH, Huang CR, Hsu TL, Lee YS. Lateral fixation of AO type-B2 ankle fractures: the Acutrak Plus compression screw technique. Int Orthop. 2010;34(6):903-907.

Headless Compression Screw Fixation Prevents Symptomatic Metalwork in Arthroscopic Ankle Arthrodesis

Publication Excerpt

“Using a headless screw fixation for arthroscopic ankle arthrodesis prevents symptomatic metalwork prominence and the requirement for removal.”

Journal Abstract

Background
Arthroscopic ankle arthrodesis (AAA) is a recognized salvage procedure for end-stage arthritis. Its reported disadvantages include a high rate of re-operation for symptomatic prominence of metalwork. We propose that the use of a headless screw would reduce this re-operation rate.

Methods
We reviewed 32 AAAs, using the Acutrak 6/7 mm headless screw fixation system, to determine peri-operative parameters and complication rates.

Results
At an average of 22 months follow-up, 28 (88%) had united radiologically. There were 2 stable fibrous nonunions not requiring further intervention. Of the other 2, one was successfully revised using an open technique, and the other patient died of unrelated causes. There were no other complications in this series, with no cases of metalwork removal for prominence or pain.

Conclusion
Using a headless screw fixation for arthroscopic ankle arthrodesis prevents symptomatic metalwork prominence and the requirement for removal.

Reference

Odutola A, Sheridan B, Kelly AJ. Headless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesis. Foot Ankle Surg. 2012;18(2):111-113.

Torsional Stiffness After Subtalar Arthrodesis Using Second Generation Headless Compression Screws: Biomechanical Comparison of 2-Screw and 3-Screw Fixation

Publication Excerpt

“Performance of the tapered, fully threaded, variable pitch screws exceeded that of conventional lag screws regardless of whether two or three screws were used. Additional resistance to internal rotation afforded by a third screw placed anteriorly may offer some advantage in patients at risk for nonunion.”

Journal Abstract

Background
Subtalar joint arthrodesis is a common operative treatment for symptomatic subtalar arthrosis. Because excessive relative motion between the talus and calcaneus can delay or prohibit fusion, fixation should be optimized, particularly in patients at risk for subtalar arthrodesis nonunion. Tapered, fully-threaded, variable pitch screws are gaining popularity for this application, but the mechanical properties of joints fixed with these screws have not been characterized completely. We quantified the torsion resistance of 2-screw and 3-screw subtalar joint fixation using this type of screw.

Methods
Ten pairs of cadaveric subtalar joints were prepared for arthrodesis and fixed using Acutrak 2–7.5 screws. One specimen from each pair was fixed with two diverging posterior screws, and the ontralateral joint was fixed using two posterior screws and a third screw directed through the anterior calcaneus into the talar neck. Internal and external torsional loads were applied and joint rotation and torsional stiffness were measured at two torque levels.

Findings
Internal rotation was significantly less in specimens fixed with three screws. No difference was detectable between 2-screw and 3-screw fixation in external rotation or torsional stiffness in either rotation direction. Both 2-screw and 3-screw fixation exhibited torsion resistance surpassing that reported previously for subtalar joints fixed with two diverging conventional lag screws.

Interpretation
Performance of the tapered, fully threaded, variable pitch screws exceeded that of conventional lag screws regardless of whether two or three screws were used. Additional resistance to internal rotation afforded by a third screw placed anteriorly may offer some advantage in patients at risk for nonunion.

Reference

Riedl M, Glisson RR, Matsumoto T, Hofstaetter SG, Easley ME. Torsional stiffness after subtalar arthrodesis using second generation headless compression screws: Biomechanical comparison of 2-screw and 3-screw fixation. Clin Biomech. 2017;45:32−37.

A Comparison of Two Headless Compression Screws for Operative Treatment of Scaphoid Fractures

Publication Excerpt

“Our study demonstrates that the Synthes headless compression screw experienced a greater loss of interfragmentary compressive force from the time of installation to the final steady state compression level. The higher post-installation compression of the Acutrak 2 Standard may be attributable to the greater number of threads throughout the entire length of the screw. The clinical significance of these results, are, at this point uncertain. We do demonstrate that a fully threaded design offers a more reliable compression that may translate to more predictable bony union.”

Journal Abstract

Purpose
The purpose of this study was to compare the interfragmentary compression force across a simulated scaphoid fracture by two commonly used compression screw systems: the Acutrak 2 Standard and the 3.0 mm Synthes headless compression screw.

Methods
Sixteen (8 pairs; 6 female, 2 male) cadaver scaphoids were randomly assigned to receive either the Acutrak 2 or Synthes screw with the contralateral scaphoid designated to receive the opposite. Guide wires were inserted under fluoroscopic control. Following transverse osteotomy, the distal and proximal fragments were placed on either side of a custom load cell, to measure interfragmentary compression. Screws were placed under fluoroscopic control using the manufacturer’s recommended surgical technique. Compressive forces were measured during screw insertion. Recording continued for an additional 60s in order to measure any loss of compression after installation was complete. The peak and final interfragmentary compression were recorded and paired t-tests performed.

Results
The mean peak compression generated by the Acutrak 2 Standard was greater than that produced by the Synthes compression screw (103.9 ± 33.2 N vs. 88.7 ± 38.6 N respectively, p = 0.13). The mean final interfragmentary compression generated by the Acutrak 2 screw (68.6 ± 36.4 N) was significantly greater (p = 0.04) than the Synthes screw (37.2 ± 26.8 N). Specimens typically reached a steady state of compression by 120-150s after final tightening.

Conclusion
Peak interfragmentary compression observed during screw installation was similar for both screw systems. However, the mean interfragmentary compression generated by the Acutrak 2 Standard was significantly greater. Our study demonstrates that the Synthes headless compression screw experienced a greater loss of interfragmentary compressive force from the time of installation to the final steady state compression level. The higher post-installation compression of the Acutrak 2 Standard may be attributable to the greater number of threads throughout the entire length of the screw. The clinical significance of these results, are, at this point uncertain. We do demonstrate that a fully threaded design offers a more reliable compression that may translate to more predictable bony union.

Reference

Grewal R, Assini J, Sauder D, Ferreira L, Johnson J, Faber K. A comparison of two headless compression screws for operative treatment of scaphoid fractures. J Orthop Surg Res. 2011;6:27.

Acutrak vs Herbert Screw Fixation for Scaphoid Nonunion and Delayed Union

Publication Excerpt

“The Acutrak screw enabled more accurate screw placement and achieved higher union rates and modified Mayo wrist scores than the Herbert screw did.”

Journal Abstract

Purpose
To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.

Methods
Records of 132 patients who underwent Herbert screw fixation (n=61) or Acutrak screw fixation (n=71) with or without bone grafting for scaphoid non-union and delayed union by a single surgeon were reviewed. The most common fracture site was the waist of the scaphoid (n=95), followed by the proximal pole (n=31) and the distal pole (n=6). Screw placement was considered accurate (n=120) when the screw was placed in the central one-third (axially) of the scaphoid; otherwise it was eccentric (n=12). Bone union was assessed radiographically and clinically. Functional outcome was assessed using the modified Mayo wrist score.

Results
Respectively in the Herbert and Acutrak screw groups, the mean patient ages were 25.3 and 27.3 years (p=0.28), the mean intervals between injury Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union and screw fixation were 12.2 and 17 months (p=0.38), the mean durations to bone union were 2.1 and 1.8 months (p=0.63), and the union rates were 77% and 93% (p=0.01). The union rate was significantly higher in fractures of the waist of the scaphoid than in the proximal and distal poles (94% vs. 71% vs. 33%, p=0.001). The union rate was significantly higher when the screw was placed accurately (axially) than eccentrically (Herbert screw: 84% vs. 40%, p=0.006; Acutrak screw: 96% vs. 0%, p=0.004). 84% of the Herbert screws were placed axially, compared to 97% for the Acutrak screws. Respectively, 67% and 85% of patients had satisfactory functional outcomes (p=0.03), whereas 23% and 7% of the patients had persistent non-union (p=0.05).

Conclusion
The Acutrak screw enabled more accurate screw placement and achieved higher union rates and modified Mayo wrist scores than the Herbert screw did.

Reference

Oduwole KO, Cichy B, Dillon JP, Wilson J, O’Beirne J. Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union. J Orthop Surg (Hong Kong). 2012;20(1):61-65.

Arthrodesis of the Thumb IPJ and Finger DIPJ with a Headless Compression Screw

Publication Excerpt

“Distal digital joint arthrodesis with the AcuTwist resulted in a fusion rate of 94% with a complication rate of 9%. Our rate of fusion compares favorably with prior series using other methods of fixation.”

Journal Abstract

Purpose
To study the results of using a small, headless compression screw (AcuTwist) for thumb interphalangeal (IP) joint and finger distal interphalangeal (DIP) joint arthrodeses.

Methods
Between November 2007 and January 2012, 48 primary arthrodeses of the thumb IP joint or DIP joint in the other digits were performed in 29 consecutive patients with AcuTwist devices. Indications for arthrodesis included 19 cases of osteoarthritis in 25 fingers, 3 cases of lupus in 9 fingers, 2 cases of post-traumatic osteoarthritis in 2 fingers, and 1 case and finger each of acute trauma, neuromuscular disorder, postinfectious osteoarthritis, boutonniere deformity, and Dupuytren contracture. Charts were reviewed for clinical data, and radiographs were assessed for alignment and healing.

Results
Age averaged 59 years and follow-up averaged 12 months (range, 2–50 mo). Union occurred in 43 out of 46 fingers (94%). There were no cases of nail deformity, wound complications, tip hypersensitivity, or clinically notable malalignment. Three arthrodesis failed to fuse, including 2 asymptomatic nonunions and 1 fixation loss requiring revision with autograft. The complication rate was 9%.

Conclusions
Distal digital joint arthrodesis with the AcuTwist resulted in a fusion rate of 94% with a complication rate of 9%. Our rate of fusion compares favorably with prior series using other methods of fixation.

Reference

Cox C, Earp BE, Floyd WE, Blazar PE. Arthrodesis of the thumb interphalangeal joint and finger distal interphalangeal joints with a headless compression screw. J Hand Surg Am. 2014;39(1):24-28.

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The Acutrak Advantage

With its introduction in 1994, Acutrak Headless Compression Screw technology revolutionized the way surgeons treat fractures, fusions, and osteotomies. Acutrak 2 introduced the next generation in fully threaded headless fixation, with larger guide wires, larger hex drivers, and a tapered end. The Acutrak 2 System is routinely used in a number of lower-extremity fracture fixations, including those featured below. Explore the Acutrak Advantage.

Jones Fracture

Medial-Lateral Malleolus Fracture

Triple Arthrodesis

Calcaneal Osteotomy

Dorsal Scaphoid Fracture

Four-Corner Fusion

Solutions for Simple to Complex Trimalleolar Injuries

Trimalleolar fractures involve the lateral malleolus, the medial malleolus, and the posterior malleolus. See how Acumed Foot and Ankle products provide solutions to treat these often challenging cases. Watch video, see clinical and biomechanical evidence, and explore case studies.

Explore Acumed Trimal Fracture Solutions

Hand Fracture Solutions That Have You Covered

From straightforward to specialized solutions, Acumed l OsteoMed offers a comprehensive portfolio of upper extremity fixation and specialty plates.

Explore Acumed | OsteoMed Hand Fracture Solutions

Features

Continuously Variable Thread Pitch
The Acutrak fully threaded continuously variable thread pitch screw design provides greater compression and a larger window of compression as compared to partially threaded Herbert style screw designs.¹ In addition, this feature allows a fracture or osteotomy site to lie almost anywhere along the length of the screw.
A Family of Options
Available in six different families for a total of 68 different screws, addressing applications throughout the upper and lower extremities.
Fully Threaded
Biomechanical studies have shown that fully threaded screws better handle the cyclic loading that may occur during healing. The Acutrak Headless Compression Screw technology has shown greater push-out strength, greater resistance to cyclic loading, and greater resistance to torsional loading when compared to differential pitch screw technology.¹
A Heritage of Healing
Over 1.7 million Acutrak family screws implanted since 1994, supported by more than 100 clinical and biomechanical studies.

1. Wheeler DL, McLoughlin SW. Biomechanical assessment of compression screws. Clin Orthop Relat Res. 1998;350:237-245.

Videos

System Overview Animation

See all videos featuring Acutrak 2

Phalangeal Fixation Animated Surgical Technique

An animated version of Acumed's suggested surgical technique for Phalangeal fractures using the Acutrak 2 Micro screw to ensure reduction of the fragment, secure the fracture, and maintain rotational stability.

Radial Styloid Fracture Reduction Animated Surgical Technique

Step-by-step animated instructions of Acumed's recommended surgical procedure using the Acutrak 2 Standard screw to reduce a radial styloid fracture, and secure it in order to maintain reduction and rotational stability.

Scaphoid Fracture Reduction Animated Surgical Technique

An animated version of Acumed's recommended scaphoid fracture surgical technique using the Acutrak 2 Mini Screw to effectively reduce and secure the fractured scaphoid, and maintain rotational stability.

Jones Fracture Reduction Animated Surgical Technique

An animated version of Acumed’s recommended surgical procedure for reducing and fixating fractures of the fifth metatarsal using the Acutrak-4.7 cannulated screw.

The Acutrak 3 Family

The Acutrak 3 Standard is designed for the fixation of small bone fractures and joint fusions, where a 3.5 mm - 4.0 mm headed screw or an equivalent-sized headless screw would otherwise be required. The Acutrak 3 Standard is extremely versatile, with a variable thread pitch and fully-threaded length that can provide excellent compression for the patient. The Acutrak 3 is indicated for: scaphoid fractures and non-unions, capitellum fractures, navicular fractures, bunionectomies, 5th metatarsal fractures, carpal fusions, and MCP fusions. Acutrak 3 Standard screws are inserted with a 2.5 mm hex driver over a .054" guide wire.

The Acutrak 3 Mini incorporates the same design principles as the rest of the Acutrak 3 family of screws, with a smaller diameter and shorter lengths. The Acutrak 3 Mini is designed for the fixation of small bone fractures and joint fusions, where a 3.5 mm - 4.0 mm headed screw or an equivalent-sized headless screw would otherwise be required. Indications for the Acutrak 3 Mini include: scaphoid fractures and nonunions, bunionectomies, radial styloid fractures, radial head fractures, avulsion fractures, carpal fusions, MCP fusions, OCD repair, and Phalangeal fractures. Acutrak 3 Mini screws are available in lengths up to 60 mm, are inserted with a 1.1mm single or double trocar guide wire and color coded corresponding option of bone drill.

The Acutrak 3 Micro incorporates the same design principles as the rest of the Acutrak 3 family of screws. The Acutrak 3 Micro is designed for the fixation of small bones and fracture fragments, where a 2.0 mm - 2.4 mm headed cruciform screw or an equivalent-sized headless screw would otherwise be required. Indications for the Acutrak 3 Micro include: radial head fractures, phalangeal fractures, carpal fractures, metacarpal head fractures, proximal pole scaphoid fractures. Acutrak 3 Micro screws are available in lengths up to 50 mm, are inserted with a 0.9 mm single or double trocar guide wire and color coded, corresponding option of bone drill.

The Acutrak 3 Nano incorporates the same design principles as the rest of the Acutrak 3 family of screws. The Acutrak 3 Nano is designed for the fixation of small bones and fracture fragments. Indications for Acutrak 3 Nano include: radial head fractures, phalangeal fractures, carpal fractures, metacarpal head fractures, scaphoid fractures, and DIP & PIP fusions. Acutrak 3 Nano screws are available in lengths up to 40 mm, are inserted with a 0.7 mm single or double trocar guide wire, and their corresponding, color coded options of bone drills.

Case Study: Acute Radial Head Fracture

Richard S. Moore, M.D., uses the Acutrak 2 Micro Screws to treat an acute right radial head fracture in a 64-year-old woman following a mechanical fall onto an outstretched hand. Who complained of pain and limited range of motion of the elbow.

View the case study

Acutrak 2 Supplemental Use Guides

Foot & Ankle: AcuTwist and Acutrak 2 Micro, Mini, Standard, 4.7, and 5.5 are intended for use as fixation devices for small bones, bone fragments, and osteotomies. They are not intended for interference or soft tissue fixation. Acutrak 2–7.5 may be used for fusions, fractures, or osteotomies of the clavicle, humerus, radius, ulna, ilium, femur, patella, fibula, tibia, talus, malleolus, and calcaneus.

Hand & Wrist: Acutrak 2 Micro, Mini, and Standard are intended for use as fixation devices for small bones, bone fragments, and osteotomies. They are not intended for interference or soft tissue fixation.

View the Supplemental Use Guides