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Insertion of the first distal locking head screw

The image intensifier should be oriented obliquely to allow accurate visualization of the point at which the K-wire exits anteromedially or posteromedially.

26 mm or 18 mm locking head screw should be used in the shaft region.

Initially, a stab incision is made and the trocar is inserted through the drill sleeve.

Battery-driven or compressed-air tools are used to insert the self-drilling, self-tapping locking head screw, as only these tools provide the required drill speed.

It is also important to cool the locking head screws with saline solution through the drill sleeve during the drilling procedure, to prevent thermal necrosis. The insertion sleeves have a side nipple to allow irrigation. Use standard tubing and syringes with saline solution.

Both the screwdriver shaft and the torque-limiting screwdriver are equipped with a self-holding mechanism. Slight pressure should be used to ensure that the screwdriver shaft penetrates the socket of the screw head on pick-up.

In case the whirlybird technique was used, the first distal locking head screw should be inserted next to it.

Note: torque-limiting screwdriver
For the final tightening the torque-limiting screwdriver has to be used. The torque-limiting screwdriver is used for final tightening until clicking occurs at 4 Nm.