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4Reduction and fixation of the articular block

Multifragmentary articular fracture

The multifragmentary articular fracture may or may not include a Hoffa injury.

In this case, separate osteochondral fragments are ideally reduced and internally fixed by lag screws. However, in certain cases, the fragment may be either too damaged or too small to be reconstructed. In this case, if a fragment is removed, a position screw rather than a lag screw should be used to avoid over-compression of the articular surface.

In the case shown fragment A has been reduced into the appropriate position. This makes it possible to compress the articular surfaces with lag screws. However, fragment B was too damaged and too small to be accurately repositioned. A void is therefore left in the articular surface. In this situation, a fully threaded 3.5 mm standard screw (position screw) is then inserted between the condyles. That is no gliding hole is used.