The first Schanz screw is inserted. If self-drilling, self-tapping Schanz screws are used, they are inserted using a slow-running power drill with continuous irrigation, through the long sleeve of the combined drill guide.
If standard Schanz screws are used, predrilling through the drill sleeve to protect the soft tissues is recommended. Schanz screws are then inserted by hand.
Great care must be taken not to insert the screw beyond the far cortex of the metacarpal to avoid injury of the palmar structures.