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One Third Tubular Plate Applied as a Neutralisation Plate

- Discussion:
    - one third tubular plate is applied as a neutralization plate in spiral frx or frxs w/ butterfly fragment, eg. in fibula & distal ulna;
    - it is applied after primary interfragmentary fixation with lag screws;
    - function of the plate is to neutralise any shearing or bending forces which could disrupt an unprotected lag screw fixation;
- Prerequisites:
    - lag screw fixation first
    - contouring of the plate
    - four to five cortices in each main fragment should be engaged;
- Technique:
    - fracture is reduced and temporary fixation is applied;
    - separate 3.5 mm cortex screw is inserted as a lag screw in the butterfly fragment using standard techniques;
    - 2.5 mm drill is used over 1st hole & 3.5 mm cortical screw is inserted;
    - second screw is placed on the opposite side of the fracture;
    - if screw hole lies over cancellous bone, use the 4.0 mm fully threaded cancellous bone screw is used in the last plate hole, usually in the  
         last screw hole