Dutch surgeons struggle with foreign screws in ski injuries
Hundreds of Dutch skiers are expected to suffer fractures in the Alps in the coming weeks, raising concerns among Dutch surgeons about the compatibility of foreign surgical screws used in Austria and Switzerland. While Alpine surgeons are highly skilled, the variety of screws, plates, and pins they use is causing difficulties for Dutch hospitals handling post-operative care, AD reports.
“If possible, wait until you’re back home before having surgery,” said trauma surgeon Kees Bartlema of the Leids Universitair Medisch Centrum (LUMC).
Bartlema has accumulated a collection of foreign medical hardware that failed to fit standard Dutch surgical tools. “In the Netherlands, we have a few suppliers for these materials, and we have the proper tools for them. In Austria and Switzerland, there are numerous small manufacturers, each with their own patents and unique screw head designs,” he said.
Identifying the type of screw used in a patient can be a challenge. “Sometimes, I have to call and ask them to mail me the correct screwdriver. I’ve even had to ask foreign surgeons, ‘What exactly did you put in there?’” Bartlema said.
The issue arises frequently in the winter season. “Almost every week, I see a case where I wonder what kind of screw was used. If complications arise and a pin needs to be replaced, a different diameter can cause major problems. It’s extremely frustrating when I realize during surgery that continuing could cause the bone to break further due to mismatched screw threads.”
The situation is well known among trauma surgeons. The challenge of mismatched screws is comparable to using a Pozidriv screwdriver on a Phillips screw. “If the tool doesn’t fit perfectly, you strip both the screw and the bit,” Bartlema explained. “When that happens inside a bone, removing the screw becomes a nightmare. I’ve had cases where I had to drill and cut it out, leaving the patient with a hole in the bone.”
He believes European regulations should mandate standardization of orthopedic materials. “We need a uniform standard for these materials across Europe,” he said.
Ski accidents and incompatible hardware
Last winter, Dutch emergency assistance provider Eurocross recorded 450 cases of Dutch skiers suffering fractures—excluding those who did not report their injuries. According to Eurocross, Dutch hospitals often struggle with screws and plates implanted abroad, sometimes forcing patients to return to the Alpine clinics for follow-up procedures.
“In extreme cases, we’ve had to suggest that a patient go back to Austria,” Bartlema said. “But expecting someone to travel 1,000 kilometers and wait in line for surgery isn’t realistic.”
In Austria and Switzerland, immediate surgery is often the norm. Private ski clinics operate on a seasonal basis, with high patient turnover essential for revenue. While surgeons at major hospitals in Austria are highly qualified, private clinics prioritize efficiency and profit, Bartlema noted.
“I’ve seen clinics with vans waiting at the slopes to recruit injured skiers and take them in immediately,” he said. “Sometimes, it’s just about making money. Recently, I treated a patient with a plate screwed onto his collarbone. It was completely unnecessary—I could barely even see the fracture.”
Floriana Luppino, a physician at Eurocross, said Dutch skiers are particularly prone to injuries. “Dutch people just aren’t good skiers,” she said. “Hospitals in Austria are already overcrowded, so they want to clear beds as quickly as possible.”
The LUMC and Eurocross recommend that skiers wait to have surgery until they return to the Netherlands, if feasible. “This is also the official advice of the Dutch Association for Trauma Surgery,” Bartlema said. “If complications arise from a foreign operation—and in 10 percent of cases, they do—it can become a serious issue. If the fracture isn’t open, you can wait a week or even ten days before surgery. Yes, waiting is painful, but temporary casts and morphine pumps can help during the trip home.”
Cost is another reason to postpone surgery. Not all travel insurance policies cover treatment at private clinics near ski resorts. Without proper coverage, a ski accident can lead to high medical expenses. Eurocross urges travelers to verify that their policy includes “winter sports coverage.”
“A helicopter rescue from the slopes can cost around 3,000 euros. Surgery can be 10,000 euros or more, and it’s not always fully reimbursed,” Eurocross warned.
