Cannulated or non-cannulated screws can be used according to the surgeon’s preference. We illustrate the use of 3.5 mm cannulated screws. A larger diameter screw may be preferred for larger bone fragments, particularly in the surgical neck region. Since interfragmentary compression is desired, use a lag screw technique, with partially threaded screws inserted so screw threads do not cross the fracture line.
Guide wire insertion
At least two screws should be inserted to fix the fracture. Therefore, insert guide wires at the foreseen cannulated screw positions. Check the position of the guide wires by image intensification.
Note: beware the axillary nerve and the bicipital tendon.
Cannulated screw insertion
Insert 3.5 mm cannulated screws of correct length over the guide wires. The screw must not perforate the articular cartilage. Use washers only in osteoporotic bone.
Remove any remaining guide and K-wires. Close wounds as needed.