Professional Documents
Culture Documents
Traumas Team
Dept. of Orthopaedic Surgery
Hasan Sadikin General Hospital
Medical School of Padjadjaran University
Bandung
Lag Screw
General Aspects
Screw very efficient tool for fixation of a
fracture by interfragmentary compression or for
fixing a splinting device (e.g : plate, nail or fixator
to bone)
The axial force produced by a screw results from
rotating screw clockwise the inclined surfaces
of its threads glide along a corresponding
surface of the bone.
General Aspects
A.
B.
General Aspects
Two force components are active
one along the circumference of the thread
one along the axis of the screw
Shaft Screws
Compression of an epimetaphyseal fracture using a
shaft screw
The thread pulls the opposite
bone fragment towards the
head of the screw.
The shaft of the screw does not
transmit any great axial force
between the shaft & the
surrounding bone.
The length of the screw shaft
must be chosen the
threaded part lies fully within
the opposite bone fragment.
Washer is used to prevent the
screw head sinking into cortex
Modes of failure
Screws can fall because of axial pull out,
bending forces, or both.
Screws usually resist axial pull out rather
well.
Most screws are fairly weak in bending
due to their small core diameter
Special Considerations of
Screw Insertion
A screw should not be tightened to the
limits of its strength, but only about 2/3 of
this allow resistance to any additional
functional loading
A.
B.
Cancellous screw
Cortical Screw
Plates
Introduction
Rigid fixation Vs Biological fixation
Rigid fixation with plates and screws has a
firm place in fracture treatment
Articular fractures require anatomical
reduction and stable fixation as callus
formation is not desired
The potential compromise of cortical blood
supply is a major draw back of
conventional plating
Special plates
Several special plates for
specific locations have
been developed
They are shaped
anatomically
corresponding to the site
where they are to be
applied
Compression by Overbending
Contouring of Plates
Straight plates often need to be contoured
prior to application to fit the anatomy of
the bone.
If this not done reduction will be lost
esp. if no lag screws are placed across
fracture
Repeated bending back & forth should be
avoided
Buttress Plate
In a metaphyseal /
epiphyseal shear or split
fracture fixation with
lag screws alone may not
be sufficient combined
with a plate with buttress
or antiglide function
In plates with DCP holes,
the screws should
inserted in the buttress
position
A plate under
tension
is much
stronger
than under
bending
forces
Bridge Plating
Indicated in complex diaphyseal fracture
patterns.
Fixed to the 2 main fragments only, leaving the
fracture zone untouched acts as an
extramedullary splint.
This concept combines adequate mechanical
stability offered by the plate with uncompromised
natural fracture biology to achieve rapid
interfragmentary callus formation & fracture
consolidation
Bridge Plating
Bridge Plating
Bridge Plating