1 Principles topenlarge
Lag screw and protection plate
Intact wedge fractures 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 but without periosteal elevation.
The positions of the lag screws depend on the fracture pattern. If possible at least one lag screw should be placed through the plate.
If necessary, 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.
2 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. To preserve the vascularity of the wedge fragment, its soft-tissue attachments must not be violated.
Smaller gauge lag screws may be used if needed to avoid comminution of small fragments.
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 plate contouring
After reducing the second main fragment using another pointed forceps, precise contouring of the plate must be undertaken.
Pitfall: risk of displaced fracture
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.
A second lag screw is placed perpendicular to the fracture plane through the plate if fracture configuration allows for it.
The fracture should be handled with caution during plate application.
Insertion of bicortical screws
The plate should be fixed to each main fragment with a minimum of three bicortical screws inserted in neutral mode.