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7Intraoperative radiological assessment

Establishment of length and rotation

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.