Executive Editor: Amy Kapatkin General Editor: Noel Moens

Authors: Bruno Peirone

Femoral shaft 32-C2

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Glossary

1 Indications top

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32-C2 (segmental fractures) with reconstructible transverse or short oblique segments are generally repaired with a compression plate.. The goal is to achieve anatomic reduction and rigid stabilization that usually leads to direct bone healing.

If comminution exists at one or both of the fracture lines, indirect reduction techniques and bridging osteosynthesis should be used.

2 Surgical technique top

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Plate selection

The length of the plate should allow placement of at least 3-4 screws in each major fragment and, if possible, at least two screws in the middle segment.

For more information please see "Plate preparation" in "Additional material".


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Reduction

The plate is contoured, secured to the proximal and distal fragment with two bone holding forceps. The central fragment is lifted up and anatomically reduced with the help of a pointed reduction forceps, a Hohmann retractor or other instruments.

An intramedullary pin may be used to help in reduction and alignment of the bone.


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Preliminary fixation

The plate is secured to the bone using bone clamps.


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Plate application

The central segment is fixed to the plate with two cortex screws inserted in a neutral mode.


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Compression is applied on the proximal side by inserting a screw in compression mode in the hole closest to the proximal fracture line. If necessary, additional compression can be applied by inserting a second compression screw in the same segment.


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Compression is applied with the same technique in the distal segment.


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The remaining screws are now inserted in a neutral fashion.


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Fixation with a locking compression plate

When a locking compression plate is used, the previous steps are the same. A push-and-pull device can be used in both proximal and distal segments in order to achieve temporary stabilization.
The central segment is fixed to the plate with two cortex screws inserted in a neutral mode.  Compression is applied on the proximal side by inserting a screw in compression mode in the hole closest to the proximal fracture line. Compression is applied with the same technique in the distal segment.
Once compression is achieved across the fracture lines, the fixation can be completed by inserting one to two locking screws in the proximal and distal segment.

Note: The plate must be anatomically contoured in the area where cortical screws are used.

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