Establishment of length and rotation
Recognize that, once a screw is inserted into the proximal segment, both the
length and the rotation of the fractured limb are established. In general, a
standard bicortical screw is first inserted into a proximal segment to bring
the plate down to the bone. The length and rotation will have been corrected by
the closed reduction techniques.
Generally, the length may be assessed by evaluating overlap or distraction
of the posterior cortex.
Place a bolster underneath the buttock of the involved extremity. A simple
“rule-of-thumb” is that the foot should be externally rotated 10° after
fixation of the supracondylar fracture. If the rotation is correct, the
anterior superior iliac spine, the center of the patella and the second toe
should be in line. Additionally, and more precisely, the rotation can be
assessed using the image intensifier with the lesser-trochanter sign.