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.
Fixation of the tuberosities
Remove K-wires and guide wires from the shaft.
Fixation of the head fragment is followed by insertion of screws in the greater and lesser tuberosity.
Again, in this case, screws are inserted over guide wires.
The illustration shows the completed osteosynthesis.
Check the reduction and the length/position of the screws by image intensification.