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Sliding Compression Screw Devices: Plate Application

- Technique:
    - Application of Plate:
          - if a small incision has been used, it may be difficult get the plate underneath the skin;
          - if so, remove the plate from the assembly device, slip it underneath the vastus and then reattach the plate into the assembly device;
          - note that it is common for a portion of the vastus to become entrapped between the plate and the bone, and therefore apply careful retraction with Bennett retractors anteriorly and a sharp Homan inferiorly;
          - use an impactor to carefully seat the plate onto the bone;
          - if the plate remains slightly proud, consider removing a portion of the vastus ridge, inorder to further seat the plate;
          - at this point the screw can be inserted to its proper depth;
    - Frx Site Impaction:
          - performed after the plate has been inserted over the screw, but prior to plate fixation;
          - release traction;
          - insert the "candle stick" in the narrow angle formed by the assembly device and the and plate;
          - impact frx w/ candle stick and mallet, and then recheck frx site reduction;
    - Insert Derotational Clip: (for Richards Sliding Screw)
          - ensure that the handle of the assembly device is in the vertical position;
          - as the deterotational clip is slid medially gently rotate the T handle back and forth until the clip slips into the screw shaft and locks in place;
    - Fixation of Plate:
          - attach the plate to the lag screw;
          - release some traction, and use the plastic bone tamp to eliminate any gaps between plate and bone;
          - manually hold the plate to the bone (or apply the Loman retractor);
          - after insertion of screw, plate should be fixed to lateral aspect of shaft with at least four cortical-bone screws.
          - use the 3.5 mm drill bit for the 4.5 mm cortical screws;
          - proximal hole can be used for a 6.5 mm cancellous screw, and in addition can be slightly angled for better purchase;
          - note that good retraction of the vastus is required distally, otherwise muscle and fascia will become entwined in the drill bit;
    - Check the Reduction:
          - palpate the anterior and posterior fracture edges to ensure that the reduction has not been lost