1 Principles topenlarge
Lag screw and protection plate
Wedge fractures with spiral or bending wedges (B1, B2) can be reduced and fixed with lag screws. An additional lateral protection plate is always needed.
This procedure can only be carried out as an open one.
Position of lag screws
The positions of the lag screws depend on the fracture pattern. If possible at least one lag screw should be placed through the plate.
Alternatively, both lag screws may be inserted outside the plate.
It is crucial to use a plate that is long enough so that at least three bicortical screws can be inserted into each main fragment.
Pitfall: risk of displaced fracture
Lag screw fixation may be tenuous. The fracture should be handled with caution during plate application. It is important to contour the plate to fit the bone perfectly so that by tightening the plate screws the fracture is not displaced and the lag screws pulled out.
2 Contouring of the plate topenlarge
Contouring of a protection plate is essential and performed as indicated by fracture configuration.
3 Reduction and Fixation topenlarge
Wedge fixation to a main fragment
As a first step, the wedge fragment is reduced to a main fragment using a pointed reduction forceps and secured in this position by a lag screw. In order to preserve the vascularity of the wedge fragment, its soft-tissue attachments must not be violated. The gliding holes of the lag screws should be in the main fragments and the threaded holes in the wedge fragment, whenever possible.
Placement of second screw
After reducing the second main fragment using another pointed forceps, a second lag screw is placed perpendicular to the fracture plane through the plate if fracture configuration allows for it.