- Discussion:
- one third tubular plate is applied as a neutralization plate in spiral frx or frxs w/ butterfly fragment, eg. in fibula & distal ulna;
- it is applied after primary interfragmentary fixation with lag screws;
- function of the plate is to neutralise any shearing or bending forces which could disrupt an unprotected lag screw fixation;
- Prerequisites:
- lag screw fixation first
- contouring of the plate
- four to five cortices in each main fragment should be engaged;
- Technique:
- fracture is reduced and temporary fixation is applied;
- separate 3.5 mm cortex screw is inserted as a lag screw in the butterfly fragment using standard techniques;
- 2.5 mm drill is used over 1st hole & 3.5 mm cortical screw is inserted;
- second screw is placed on the opposite side of the fracture;
- if screw hole lies over cancellous bone, use the 4.0 mm fully threaded cancellous bone screw is used in the last plate hole, usually in the
last screw hole