One Third Tubular Plate Applied as a Tension Band Plate

- Prerequisites:
    - plate is applied as a tension band in certain short oblique or transverse fractures, eg. the fibula, the metatarsus, the distalu lna and the 
    - 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

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 9, 2011 1:50 pm