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DCP 3.5 mm Applied as Self Compression Plate w/ Lag Screw Thru Plate

 - See:  Synthes Plates and Screws:3.5 MM DCP, LC-DCP 3.5 MM LCP  4.5 MM LCP RECONSTRUCTION PLATE 

- Discussion: 
    - this technique is used in oblique frxs, where optimal stability can be  achieved by combining the self compression effect of DCP for axial
         compression, and the interfragmentary compression of a lag screw;

- Prerequisites:

    - plate is contoured to the bone and placed such that one plate hole  can be used for the lag screw;
    - six cortices in each main fragment should be engaged by the screws;

- Technique:

    - fracture is reduced and the contoured plate is placed on the bone  with the wider middle portion over the fracture;
    - plate hole is left vaccant for an angled screw thru the plate;
    - plate is held in position with two reduction forceps;
    - on fracture side (w/ obtuse angle), the 2.5 mm drill with the neutral drill bit, and a 3.5 mm cortical screw is inserted;
    - 3.5 mm cortex screw is inserted but not fully tightened;
    - plate is pulled towards the opposite fragment to place the screw in the eccentric position in the plate hole;
    - on opposite side of the fracture, the first screw hole is left vaccant for the lag screw;
    - in the next screw hole, the load (yellow) DCP drill guide, 3.5 mm  is placed with the arrow pointing towards the fracture;
    - drill hole is drilled with the 2.5 mm drill bit;
    - hole is tapped, and the 3.5 mm cortical screw is inserted but not fully tightened, until the first screw (on the other side of  fracture) is fully tightened;
    - position for the oblique lag screw thru the plate is determined;
    - angulation of the screw must not exceed 25 deg longitudinally  (40 deg for LC-DCP) and 7 deg transversely;
    - gliding hole is drilled in the near cortex using the 3.5 mm drill bit in the double drill sleeve end, 3.5 mm;
    - 2.5 mm end of this sleeve is then pushed into the hole until it  abuts the endosteal cortex of the far fragment;
         - the thread hole is drilled with the 2.5 mm drill bit;
         - the 3.5 mm cortical lag screw is inserted