Equipment/AO

Question 1

How are screws placed in a STABILIZATION plate vs a COMPRESSION PLATE?

Answer 1

Stabilization plate
Already achieved compression through lag screws
Screws in the plate are put in concentrically (aimed at center of hole)
Compression plate
Drill some screws in eccentrically (aimed at far side of hole) to bring the bones together, causing compression
Put in the middle screws first eccentrically, and the outer screws concentrically

Question 2

How should the ankle be placed for a Syndesmostic Screw?

Answer 2

Syndesmotic screw
Talus is wider anteriorly
Aim for foot at neutral position

Place ankle in neutral to slightly DF
Because the anterior talus is wider with respect to the posterior talus
Fixation with the ankle in dorsiflexion will result in the ankle being too loose upon healing
Fixation with the ankle in plantarflexion will result in the ankle being too tight upon healing

Question 3

Why should I remove screws in a young patient vs an old one?

Answer 3

REMOVE screws in YOUNG patients
Old patients– leave screws in for support
Young patients-
1) Bones become dependent on the metal, get osteoporotic
2) Bones adjacent to the screw become washed out

Question 4

When do I need to fixate a fracture?

Answer 4

Any fracture comprising greater than 25% of the articular surface will need to be fixated; cannot rely on Vassal phenomenon

Question 5

What is the order of steps to place a screw?

Answer 5

. Overdrill, underdrill, countersink, measure, tap and insert with two finger tightness

OH YOU C ME TAP THAT

Question 6

If primary bone healing is my goal- what plate do I want to use?

Answer 6

With primary bone healing as the goal, you want a compression plate with eccentrially placed screws. Holes in the plate are labeled B, C, A and then D with A most distal and D most proximally located. B and C screws are drilled where they hit the inside of the plate hold. You offset drill the closest holes on either side the fracture line positioned away from the fracture line.