Basic techniques of fracture management

 
 
 

Cortical lag screw insertion

 
 
 
 
 
 
 
 

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 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.

Insertion of a cortical lag screw

Cancellous lag screw insertion

 
 
 
 
 
 
 
 

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 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.

cancellous lag screws

Headless compression screw insertion

 
 
 
 
 
 
 
 
A headless compression screw may be used to stabilize fractures of and around joint surfaces, especially articular and periarticular fragments to which ligaments are attached.
Its head is sunken or flush with the joint surface to avoid impingement.
The screw may be inserted percutaneously through a stab incision or via an open approach.
A headless compression screw may be used to stabilize fractures of and around joint surfaces, especially articular and periarticular fragments to which ligaments are attached.
Its head is sunken or flush with the joint surface to avoid impingement.
The screw may be inserted percutaneously through a stab incision or via an open approach.
Headless compression screw insertion

Modular external fixation

 
 
 
 
 
 
 
 

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

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

basic technique modular external fixation

Plating

 
 
 
 
 
 
 
 

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

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

Lag screw fixation protected by a neutralization plate

Compression plate application to oblique fractures

 
 
 
 
 
 
 
 

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

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

Compression plating of an oblique shaft fracture

Compression plate application to transverse fractures

 
 
 
 
 
 
 
 

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

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

Insertion of second compression screw

Screw insertion in compression mode

 
 
 
 
 
 
 
 

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

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

Screw insertion in compression mode

Screw insertion in neutral mode

 
 
 
 
 
 
 
 

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

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

Screw insertion in neutral mode

Locking head screw insertion

 
 
 
 
 
 
 
 

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.

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.

Locking head screw  inserted in a plate

Intramedullary nailing

 
 
 
 
 
 
 
 

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).

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).

Intramedullary nailing of a tibial shaft fracture

Casting/splinting of upper limb

 
 
 
 
 
 
 
 

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 upper limb.

Long arm cast

Casting/splinting of lower limb

 
 
 
 
 
 
 
 

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

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

Circular cast for treatment of malleolar fractures