Executive Editor: Chris Colton

Authors: Peter V Giannoudis, Hans Christoph Pape, Michael Sch├╝tz

Femur shaft 32-B2 ORIF midshaft

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1 Principles top

Principles enlarge

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.

Principles enlarge

Alternatively, both lag screws may be inserted outside the plate.

Principles enlarge

Plate length

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.

Principles enlarge

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 top

Contouring of the plate enlarge

Contouring of a protection plate is essential and performed as indicated by fracture configuration.

3 Reduction and Fixation top

Reduction and Fixation enlarge

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.

Reduction and Fixation enlarge

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.

4 Fixation of the protection plate top

Fixation of the protection plate enlarge

Insertion of bicortical screws

The plate should be fixed to each main fragment with a minimum of three bicortical screws.

v1.0 2007-12-02