Executive Editor: Chris Colton, Rick Buckley

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

Femur shaft - Simple, spiral, middle 1/3 fractures

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Glossary

1 Principles top

Femoral shaft – Lag screw and protection plate - Principles enlarge

Lag screw through protection plate

Simple oblique or spiral fractures or intact wedge fractures can be reduced and fixed with lag screws. An additional protection plate is always needed and ideally the lag screw is inserted through the plate.

This procedure can only be carried out as an open one.


Femoral shaft – Lag screw and protection plate - Principles enlarge

If necessary, the lag screw may be inserted outside the plate.


Femoral shaft – Lag screw and protection plate – Plate length 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.

2 Reduction and contouring of the plate top

Femoral shaft – Lag screw and protection plate – Reduction and contouring of the plate enlarge

After reduction of the main fragments using pointed forceps, precise contouring of the plate must be undertaken.


Femoral shaft – Lag screw and protection plate – Principles enlarge

Pitfall: risk of displaced fracture

It is important to contour the plate to fit the bone precisely so that tightening the plate screws does not displace the fracture and might pull out the lag screw.

3 Fixation top

Femoral shaft – Lag screw and protection plate – Lag screw fixation enlarge

Lag screw insertion

The lag screw is inserted perpendicular to the fracture plane, through the appropriate plate hole. Occasionally, a lag screw of a smaller gauge is used to avoid causing additional fractures.

At this stage, careful handling is mandatory to avoid any stress on the lag screw!


Femoral shaft – Lag screw and protection plate – Bicortical screws enlarge

Insertion of bicortical screws

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


Femoral shaft – Lag screw and protection plate – Leg screw outside plate enlarge

Alternative: lag screw outside plate

Illustration shows the completed osteosynthesis with the lag screw inserted outside the plate.

v2.0 2018-07-05