If the hold of lag screws alone is inadequate, a neutralization device such as a plate or an external fixator may be used to provide additional stabilization.
The plane of the fracture dictates the position of the lag screw. Anatomic considerations will influence the optimal positioning of the plate.
If the plate position and lag screw insertion site are aligned, the lag screw may be inserted through the plate.
The plate should be contoured and positioned appropriately. Then, with the fracture reduced, the lag screw is inserted through the plate first, as described below. The remaining screws are then inserted through the plate.
If the fracture plane necessitates that the lag screw is inserted from a position where it would be awkward to apply a plate, the lag screw can be inserted outside the plate. The fracture should be reduced and the lag screw inserted first. The neutralization plate is then applied.