Sliding Compression Screw Devices - Wheeless' Textbook of Orthopaedics

- Reaming Procedure:
- set triple reamer to proper length;
- in osteoporotic bone, set reamer to 5-10 mm < length of guide pin to reduce chance of pin withdrawl & to allow
better purchase of lag screw in unreamed bone;
- it is essential that the proximal "triple reamer" base fully engage the outer cortex of the proximal femur inorder to create
enough room so that the barrel of the plate can fit over the lag screw;
- ream to proper depth, indicated by the depth stop;
- remove reamer by pulling it and turning it clockwise, so as not to remove guide pin;

- Screw Insertion:
- insert bone tap upto an appropriate depth based on quality of bone;
- w/ especially hard bone found in young patients, it is especially important to to tap upto the threads of the guide pin;
- inadequate tapping may cause excessive torque during screw insertion, which may cause rotational malalignment;
- in addition to complete tapping, consider insertion of a second Steinman pin to prevent proximal fragment rotation;
- assemble screw, plate, and locking clip onto insertion wrench;
- screw the distal assembly so that it locks into the lag screw;
- use marks on screw and barrel to determine appropriate depth of screw insertion and proper orientation of screw
to barrel so that locking clip can be applied;
- as the screw is being inserted, rotate the plate anteriorly so that it can be used as a handle to help guide screw insertion;
- insert the screw about 2/3 of the way down and then slip the plate underneath the skin and muscle so that it rests on the lateral surface of the femur;
- note that one full turn of screw = 3 mm;
- Pearls: following screw insertion, the surgeon should palpate the anterior and posterior fracture edges to ensure that
the reduction has not been lost;