Application of compression plate to transverse fractures

The plate produces compression at the fracture site to provide absolute stability.

If possible, the fracture is reduced and temporarily fixed with clamps. Place the forceps such that they will not interfere with the planned plate position.

If the plate is exactly contoured to the anatomically reduced fracture surface, there will be some gapping of the far cortex when the plate is tensioned by tightening the load screw.

The solution to this problem is to “over-bend” the plate so that its center stands off 1–2 mm from the anatomically reduced fracture surface.

The overbend should lie directly over the fracture line.

When the first screw is inserted, slight gapping of the cortex will occur directly underneath the plate. After fixation is complete, the plate will be in contact with the bone throughout its length, but it is acting as a spring, providing compression at the far cortex.

The prebent plate is fixed to one of the main fragments with a screw inserted in compression mode. Reduction forceps are placed on the opposite fragment to hold it in the reduced position against the plate. The screw is not fully tightened.

A screw is inserted in compression mode in the opposite fragment. To maintain reduction, it is recommended to tighten the screws gradually by alternating between the two sides.

If there remains a fracture gap after insertion of the two compression screws, a third screw can be inserted in compression mode mode on either side. Before this screw is tightened, the compression screw already placed in the same fragment needs to be loosened. After the third screw is fully tightened, the first screw is re-tightened and additional screws are inserted in neutral mode.

Application of dynamic compression plate to transverse fractures.