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Both Bone Forearm Frx: Surgical Fixation

- Discussion:
    - lag screw: (see: lag screw theory)
             - in oblique or wedge fractures 3.5 mm cortex screws are inserted as lag screws either separately first or thru the plate;
    - radial frx:
             - radial plate is most often placed on the anterior surface but it may also be placed on the dorsal radial surface;
             - because the radius is slightly convex on the dorsal surface, then consider prebending the plate inorder to avoid having the far
                        cortex (volar surface) distract as the near cortex (dorsal) is compressed as the dynamic compression is applied;
    - ulnar frx:
             - for frx of ulna, plate is placed on either volar or dorsal surface;
             - only frx site & surface on which plate is applied is stripped;
    - insertion technique for 3.5 mm DCP and for 3.5 mm LC-DCP in pure titanium:
             - contouring of the plate using the malleable templates;
             - fixation of the plate provisionally to one main fragment with a screw and to the other side with a small reduction
                      forceps (or screw);
             - second bone is approached and its fracture exposed;
             - use 6-8 hole plate because the screws must engage a minimum of 5 cortices on either side of the fracture to obtain fixation;
             - place the distal screws first;
             - no screw should be within 1 cm of the fracture site;
                  - if screws are placed closer than this a crack may develop between screw & frx as compression is applied &
                            fixation with be lost;
                  - it is therefore better to select a longer plate and leave one or two holes empty;
             - apply the neutral drill guide in the hole nearsest the fracture;
             - insert the screw but do not seat it completely;
             - next drill the nearest available hole on the opposite side of the frx using the eccentric drill guide;
             - seat completely neutral drill hole, and then the eccentric screw in their respective holes;
             - if frx is oblique, consider apply a lag screw thru the plate;
             - lag screw is applied last

Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna.

Compression-plate fixation in acute diaphyseal fractures of the radius and ulna.

Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compression plate