Note: The first principle (A) will be described using two different techniques.
Interfragmentary compression
Interfragmentary compression can be achieved by a lag screw, inserted either through a plate hole (1), or separate from the plate (2).Axial compression
Interfragmentary compression can be achieved by loading the oblique fracture site axially, using specific techniques.Axial compression, using self-compressing plates (DCP, LC-DCP, LCP, etc.), is achieved by eccentric screw placement.Reduce the fracture anatomically, using a reduction forceps on each main fragment. The use of blunt, as opposed to pointed, reduction forceps can be helpful, particularly if greater forces are required.
A small bone lever can be used to reduce the fragments.
Reduction of overlapping oblique fractures can sometimes be achieved by twisting a reduction forceps, thereby lengthening the fracture.
Maintain the fracture reduction with pointed reduction forceps. Place the forceps such that it will not interfere with the planned plate position.
Note: Because of the design of the LC-DCP holes, the neutral drill guides for the LC-DCP have a very slightly eccentric hole and an arrow, which needs always to point towards the fracture line.
Note: the arrow on the drill sleeve has to point towards the fracture line.
Check the completed osteosynthesis by image intensification. Make sure that the plate is at a proper location, the screws are of appropriate length and a desired reduction was achieved.
The elbow should be stabilized at the epicondyles and the forearm rotation should be checked between the radial and ulnar styloids.
Before starting the operation the uninjured side should be tested as a reference for the injured side.
After fixation, the distal radioulnar joint should be assessed for forearm rotation, as well as for stability. The forearm should be rotated completely to make certain there is no anatomical block.
The elbow is flexed 90° on the arm table and displacement in dorsal palmar direction is tested in a neutral rotation of the forearm with the wrist in neutral position.
This is repeated with the wrist in radial deviation, which stabilizes the DRUJ, if the ulnar collateral complex (TFCC) is not disrupted.
This is repeated with the wrist in full supination and full pronation.
In order to test the stability of the distal radioulnar joint, the ulna is compressed against the radius...
...while the forearm is passively put through full supination...
...and pronation.
If there is a palpable “clunk”, then instability of the distal radioulnar joint should be considered. This would be an indication for internal fixation of an ulnar styloid fracture at its base. If the fracture is at the tip of the ulnar styloid consider TFCC stabilization.