- Technique:
- Application of Plate:
- if a small incision has been used, it may be difficult get the plate underneath the skin;
- if so, remove the plate from the assembly device, slip it underneath the vastus and then reattach the plate into the assembly device;
- note that it is common for a portion of the vastus to become entrapped between the plate and the bone, and therefore apply careful retraction with Bennett retractors anteriorly and a sharp Homan inferiorly;
- use an impactor to carefully seat the plate onto the bone;
- if the plate remains slightly proud, consider removing a portion of the vastus ridge, inorder to further seat the plate;
- at this point the screw can be inserted to its proper depth;
- Frx Site Impaction:
- performed after the plate has been inserted over the screw, but prior to plate fixation;
- release traction;
- insert the "candle stick" in the narrow angle formed by the assembly device and the and plate;
- impact frx w/ candle stick and mallet, and then recheck frx site reduction;
- Insert Derotational Clip: (for Richards Sliding Screw)
- ensure that the handle of the assembly device is in the vertical position;
- as the deterotational clip is slid medially gently rotate the T handle back and forth until the clip slips into the screw shaft and locks in place;
- Fixation of Plate:
- attach the plate to the lag screw;
- release some traction, and use the plastic bone tamp to eliminate any gaps between plate and bone;
- manually hold the plate to the bone (or apply the Loman retractor);
- after insertion of screw, plate should be fixed to lateral aspect of shaft with at least four cortical-bone screws.
- use the 3.5 mm drill bit for the 4.5 mm cortical screws;
- proximal hole can be used for a 6.5 mm cancellous screw, and in addition can be slightly angled for better purchase;
- note that good retraction of the vastus is required distally, otherwise muscle and fascia will become entwined in the drill bit;
- Check the Reduction:
- palpate the anterior and posterior fracture edges to ensure that the reduction has not been lost