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6Plate fixation to the proximal fragment

Using the articulated tension device

Reduction of metaphyseal fracture component

The key concept in reduction of the metaphyseal fracture component when utilizing a DCS is that insertion in the distal femur allows the surgeon to use the plate to assist the metaphyseal fracture reduction. The surgeon must control for length, rotation and sagittal plane deformity (hyperextension/hyperflexion). When performed in an open manner, length can be restored by manual traction. The sagittal plane deformity correction can be aided by a supracondylar bolster.

Loosely secure the plate to the proximal femur with a Verbrugge clamp.

Take care to restore the mechanical axis of the femur in all planes. Give consideration to fracture reduction in:

  • Varus/valgus
  • Flexion/extension
  • Internal/external rotation
  • Translation
  • Lengthening/shortening

Use of the articulated tension device
Secure the articulated tension device to the proximal femur with a bicortical screw.

The articulated tension device is very useful to apply controlled compression to the fracture site. It should be used when possible in fracture patterns where there is contact between the proximal and distal main fragments. It may not be used in situations of severe metaphyseal comminution and/or osteoporosis.