Don't forget the washer


A 50 year old patient with anterior ankle impingement underwent anterior ankle arthroscopy for screw removal. The screw was inserted for fixation of a bimalleolair ankle fracture 5 years before. The screw was removed under arthroscopic view. The washer was lost from the screwtip (picture 1). The screw was pushed back in order to catch the washer (picture 4), after which it was grasped with a small grasping forceps which was inserted through a third portal (picture 5).

Picture 1: Picture showing washer (2) lost from the screw (3), at the background the hole where the screw originated from (1)  

Picture 2: Radiograph showing position of screw and in the medial malleolus.

Picture 3: Picture showing removal of screw (3) and washer (2) from medial malleolus bone (1). 

Picture 4: Picture showing balancing of the washer (1) on the tip of the screw (2). 

Picture 5: Picture showing removal of washer (1) by means of a grasper (3), the screw can be seen in the background (2)