Basic techniques of fracture management

The function of the cortical lag screw is to compress one piece of bone against another. This improves the stability of a reduction, so it is commonly used to achieve absolute stability, leading to direct bone healing, as opposed to healing with callus.

The function of the lag screw is to compress one piece of bone against another. This improves the stability of a reduction, so it is commonly used to achieve absolute stability, leading to direct bone healing, as opposed to healing with callus.

The modular external fixator is optimal for temporary use. It is rapidly applied without need for intraoperative x-rays and can be adjusted later.

Plates may be applied in various modes according to the function required. These include protection (neutralization), compression, bridge, and buttress (antiglide) plating.

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

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

The principle of applying dynamic compression depends on relative movement between the bone and the plate as the screw is tightened.

When a non-locking screw is inserted into the middle of a plate hole, it presses the plate straight down onto the bone.

As a locking head screw is tightened, the thread on the head engages with the thread of the plate and locks the screw to the plate at a 90° fixed angle or variable angles (up to 15° off the nominal axis). These constructs provide angular stability.

An intramedullary (IM) nail provides the strongest mechanical fixation of any shaft fracture.
There may be practical reasons (eg, existing hardware or a small intramedullary canal) or biological reasons (eg, soft tissue concerns) why other methods would be chosen.
Nailing may be performed antegrade (proximal to distal) or retrograde (distal to proximal).

This page contains a list of videos on cast and splint application to the upper limb.

This page contains a list of videos on cast and splint application to the lower limb.