REX Ortho
Overcoming the Expandable Screw Compromise: Strong Fixation with Reliable Removal

Orthopaedic fixation is a balancing act between strength and adaptability. Surgeons need implants that hold firm in fragile or compromised bone, but also recognize that the long-term clinical journey is unpredictable. Fractures can recur, infections develop or adjacent pathology emerge—sometimes years later—requiring the implant to be removed. For expandable screws, this has historically presented a challenge: while they improve fixation strength, their removability is often poor, with some designs risking bone ingrowth or mechanical failure on extraction.

REX Ortho’s Removable and Expandable (REX) Screw changes that

The REX Screw provides significantly improved fixation strength through an internal wing expansion mechanism that deploys within the cancellous bone—particularly effective in osteoporotic or unstable fractures. This expansion distributes load over a larger bone volume, reducing the risk of the screw pulling out of the bone under physiological loading. Yet critically, unlike other expandable screw technologies, the REX Screw has been engineered for controlled, clean removal. Its unique “gapless” design prevents bone ingrowth into the mechanism and the wings retract along the same axis they deploy, enabling low-torque, low-trauma extraction.

This design decision was driven by direct surgeon input. While many expandable screws achieve better fixation, their poor removability has limited adoption—particularly in trauma cases where revision may be needed. REX Ortho understood that performance isn’t just about holding. It’s about preparing for what comes next.

“We listened to what surgeons needed and designed our product around it. The REX Screw delivers robust fixation without locking surgeons into a permanent solution,” says Ian Brown, co-founder. “It expands when increased fixation strength is needed, but it can be removed cleanly if conditions change, offering confidence not just in the moment of fixation but also if revision is ever needed, aligning with real-world clinical needs. And because it fits into the existing procedure without adding time or requiring new training, it brings assurance without disruption.”

That philosophy—make it strong, but make it simple—runs through everything REX Ortho brings to the table. It has developed a platform of implants based on the same removable-expandable core technology, each tailored to a different clinical challenge. The F-REX Screw is built for hip fractures, where poor bone quality can lead to screws penetrating through the hip joint under walking loads, requiring the patient to have a total hip replacement surgery. The L-REX Screw, used in lumbar spine fusion, offers the same expansion technology in spinal applications, where stability is critical to prevent pain. And it’s not just theory—testing shows REX’s expandable hip screws deliver around five times more gait cycles to failure than traditional screws. A three-month animal study showed that the screw’s expandable wings could be cleanly retracted even after bone growth—evidence that its removability holds up under realistic conditions.

REX Ortho has completed all testing required for FDA 510(k) clearance for their F-REX screw and are now preparing for a clinical trial. While clinical trials weren’t mandated, the company chose to move forward with them to demonstrate performance, not just claim it.

The first of these trials is launching in Sweden, led by surgeons who have reviewed REX Ortho’s lab and animal data and want to see the same outcomes in human cases. Their interest speaks to more than curiosity—it’s a vote of confidence from professionals who’ve seen too many implants that either fail to hold or become impossible to remove.

This clinical momentum is supported by strong partnerships. REX has built collaborative ties with organizations like the AO Foundation—the world’s largest surgeon network—and GLW Medical Innovations in the U.S., a fast-growing orthopaedic startup company. These alliances are part of a broader strategy to embed REX technology into trusted surgical workflows.

It’s REX’s surgeon-led development process that truly defines its difference. Rather than designing in isolation, the team engaged directly with orthopedic specialists, listening, iterating and refining based on what actually happens in the OR. That hands-on, iterative process has shaped a product that feels familiar in the OR, reducing stress and supporting better outcomes for both patients and providers.