1 Principles topenlarge
In case of a simple fracture pattern absolute stability is mandatory. You can achieve this with lag screw technique. Depending on the fracture pattern the lag screw could be through the plate (illustrated here) or outside the plate.
For such fracture pattern where the lag screw is outside the plate, the lag screw is applied first then a plate is used as a neutralization plate.
Monitor the neurovascular status of the limb carefully not to miss a compartment syndrome.
2 Reduction topenlarge
Indirect reduction may be achieved by external manipulation of the fractured fragment using clamps. In cases where adequate closed reduction is not achieved, open anatomical reduction is required.
Pearl: clamp on plate
If you intend to keep the clamp on throughout the whole procedure it is best to slip the plate under the clamp prior to tightening the clamp to maintain reduction. Under these circumstances you determine which screw hole is best for the placement of the tip of the clamp from the pre-operative plan and intra-operative trial.
3 Fixation topenlarge
Lag screw through the plate
First, the lag screw is applied through the plate using the conventional lag screw technique.
Click here for a detailed description of the lag screw technique.
Additional screw insertion
If possible three bicortical screws on each side of the fracture should be applied. No particular order of insertion has to be followed.
Alternative: lag screw outside the plate
Illustration showing the lateral projection of the use of a lag screw outside the plate.