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Removal of the insertion guide, and placement of the “A” proximal tibial locking head screw

The insertion guide is then disconnected from the fixator. Insert a locking head screw or a screw hole inserter into the “A” proximal tibial screw position.

Intraoperative assessment of fracture stability after fixation
Specific questions to be answered in this assessment include:

  • Are all of the screws really placed monocortically into the bone, or are some positioned too far anteriorly or posteriorly?
  • Are any of the locking head screws in the popliteal fossa and endangering the popliteal artery? (Although rare, this can occur with excessive anterior positioning of the fixator or malreduction where the shaft is internally rotated with respect to the proximal fragment.) This can be assessed intraoperatively and by image intensification.
  • It should be checked that self-drilling, self-tapping locking head screws have not perforated the medial cortex.