Correct placement
Compromised
screw purchase
DePuy Synthes
35
Tips
If the reduction of the fracture causes difficulties, insert a
Schanz screw antero-medially in the distal fragment, and use
the screw as a joystick. The insertion of a Schanz screw or
pulling device into the proximal fragment can also be very
beneficial. Should it still be impossible to perform a correct
reduction, improve the access by enlarging the soft-tissue
opening.
Bending and twisting of the plate is not recommended as it
may result in a misalignment between the holes of the inser-
tion guide and the corresponding plate holes.
Should the plate lie too ventral or too dorsal, the screws can-
not be centred in the medullary canal. This position may
compromise screw purchase (see illustration).
Both screwdriver shaft and torque-limiting screwdriver are
equipped with a self-holding mechanism. Apply slight pres-
sure on pick-up to ensure that the screwdriver shaft pene-
trates the recess of the screw head.
Should the screwdriver be difficult to remove after insertion,
disconnect it from the power tool and remove the drill
sleeve. After reconnecting the screwdriver to the power tool,
withdraw the screwdriver from the screw.
Standard 4.5 mm cortex screws can be used through the in-
sertion guide if required. Note that cortex screws cannot be
inserted through the drill sleeve for LISS insertion guide.
Hole A serves to lock the insertion guide to the implant. This
hole cannot be used for the insertion of a screw as long as
the fixation bolt is attached. If a screw has to be inserted in
hole A, remove the fixation bolt – with the stabilization bolt
still in place – and attach it in an adjacent hole. Place the drill
sleeve in hole A (pre-drill if necessary) and insert the appro-
priate screw. If all holes are occupied by a screw, the screw in
hole A can be inserted by free-hand technique. Use the di-
rection given by the fixation bolt prior to removal of the in-
sertion guide to determine the correct direction for insertion.
To ensure stability of the construct, the most proximal screw
should be inserted last, just before removing the insertion
guide. Remove the stabilization bolt and insert the screw
through the drill sleeve.
If hole A is unoccupied, it must be closed with a Screw Hole
Insert (422.390) to facilitate the application of the insertion
guide for removing the implant.
