X-Bolt

Surgeon FAQs

How easy is it to remove?

Very easy. Just use a standard screwdriver to retract down the wings.

What if bone has formed under the wings?

The car-jack mechanism is powerful enough to crush new bone formed under the wings. Note also that the tissue (blood/collagen/bone) underneath the wings of the bolt will not be loaded (stress-shielded), so maturity to strong bone is unlikely. 

Why isn’t the X-Bolt cannulated?

Note that a guidewire is used as standard for accurate position of reaming. The reaming step is performed as standard. Frequently the guidewire comes out with the reamer on completion of the reaming step.

Notwithstanding, this reamer guidewire is utterly useless to maintain temporary fracture reduction, as has no proper bony anchorage. A second guidewire is recommended always to be used to maintain fracture reduction in unstable fracture patterns.

A guidewire is necessary for a lag screw, which can easily get cross-threaded on insertion and create a false passage.

An X-Bolt slots exactly into the reamed drill-hole. It should advance and self-centre easily. Note that forcing it may create a false passage, but one should be aware and follow on both fluoroscopy views in any event.

Additionally, a cannulation would weaken the overall strength of the bolt, cost would be slightly higher, and might create another surface for infection, though all are of low risk.

Does the fracture get compressed as the X-Bolt deploys?

No. The X-Bolt opens in-situ without any compression or distraction of the fracture site. Fracture compression happens only due to the sliding mechanism of the shaft (identical to typical SHS or nailing systems).

Can I ream short of the optimum (deep) tip-apex point?

The final implant position is determined by the reaming step. The X-Bolt cannot advance deeper beyond what has been reamed. Therefore, freehand reaming under fluoroscopy may be required to achieve the optimum (deep) tip-apex point.

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