One Third Tubular Plate Applied as a Tension Band Plate - Wheeless' Textbook of Orthopaedics

- Prerequisites:
- plate is applied as a tension band in certain short oblique or
transverse fractures, eg. the fibula, the metatarsus, the distal
ulna and the olecranon;
- plate must be placed on the tension side of bone;
- plate is contoured to the shape of the bone using a template model;
- in transverse fractures the plate is also slightly overbent;
- axial compression is achieved by eccentric placement of screws in
plate holes adjacent to the fracture;
- five to six cortices in each main fragment should be engaged;
- Technique:
- first screw hole (proximal) is drilled in one of the plate holes
near the fracture using the 2.5 mm drill bit in the double drill
sleeve end, 2.5 mm;
- hole is tapped for the 3.5 mm tap;
- 3.5 mm cortical screw is inserted but not fully tightened;
- after insertion of the first screw, the plate is then pulled towards
fracture to place this screw in the eccentric position;
- in plate hole near the fracture in the opposite fragment (distal),
second screw hole is drilled with the 2.5 mm drill bit and the
double drill sleeve end, 2.5 mm;
- drill hole is placed in the eccentric (load) position, away
from the fracture site;
- if distal screw hole comes to lie in cancellous bone, a 4.0 fully
threaded cancellous bone screw is chosen;
- 4.0 cancellous bone tap (3.5 mm double drill sleeve);
- 2nd screw is fully tightened, and then the first screw is tightened
- oval holes permit eccentric positioning of screws, which can be used
for axial compression of the fracture;
- to acheive this, wide middle section of plate is placed over fracture;
- screws nearest the fracture in each fragment are inserted
eccentrically away from the fracture;
- plate is fixed with 3.5 mm cortex screws in diaphyseal bone, and
4.0 mm cancellous bone screws in the metaphysis;