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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 
         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