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Definitive fixation

Percutaneously inserted screws to fix the head fragment

Fixation of the head fragment

Two or more percutaneously inserted screws linking the shaft fragment to the head fragment are inserted first.
Cannulated 3.5 mm lag screws (as illustrated), or non-cannulated small fragment lag screws are used according to the surgeon’s preference.
This illustration shows two screws inserted over guide wires.
Note: Washers may be advisable in poor bone stock. Generally, they are not preferable as they make the screw heads more prominent and may result in shoulder impingement.