Application of compression plate to transverse fractures

Function

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

Application (transverse fractures)

Reduction

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.

Reduced fracture
Pre-contouring

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.

Plate applied with fracture gap of the far cortex

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.

Effect of overbending the plate
Screw insertion

The prebent plate is fixed to one of the main fragments with a screw 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.

Insertion of first compression screw

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.

Insertion of second compression screw

If there remains a fracture gap after insertion of the two compression screws, a third screw can be inserted in compression 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.

Further compression by insertion of third screw in compression mode
Teaching video

Application of dynamic compression plate to transverse fractures.

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