Basic instruments for standard

screw- and plate fixation

Isabel Van Rie Richards

AOTrauma Education for ORP

Bali, Indonesia
28-30/05/09

Learning outcomes
1. Prepare all basic instruments needed for large
fragment screw & plate fixation step by step
2. Explain which instruments are used to apply a
lag screw
3. Discuss the different instruments needed to
obtain dynamic compression with a plate

Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation
1.
2.
3.
4.
5.

Drill the hole

Use the countersink
Measure
Tap
Insert the screw

Pointed forceps (Weber)

Several sizes available
Available with ratchet
closure or with speed
lock
1 or 2 instruments
are used

With ratchet

Forceps with serrated jaws

Also used for temporary
plate fixation
Several sizes available
Available with speed lock
1 or 2 instruments
are used

Self-centering forceps (Verbrugge)

Also used for temporary
plate fixation
Available with speed
lock
1 or 2 instruments
are used
Adjustable to size
of fragment

Self-centering
jaws

Sharp hook (Dentist)

Reduction of small fragments
Used to clean the fracture gap, screw recess
and the tap & drill bit

Elevators & Hohmann

Elevators: dissection
Hohmann: retractor
Adapt the instrument size to the fracture site

Femoral distractor
Opens the fracture site so that reduction of
smaller fragments is possible
Nuts
Rod

Sleeves

Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation
1.
2.
3.
4.
5.

Drill the hole

Use the countersink
Measure
Tap
Insert the screw

Bendingtools
Bending press
1

Templates
Bending irons

Flexible templates
1

Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation
1.
2.
3.
4.
5.

Drill the hole

Use the countersink
Measure
Tap
Insert the screw

Drill bit
Tip
Flutes
Quick
coupling

Drill bit
2-fluted

3-fluted

Strong
Standard use

Enables drilling at a sharp

angle
Less strong

Table of drill bits & taps

Screw

Drill bit
Drill bit
threaded gliding hole
hole

Tap

Cortical

4.5

3.2

4.5

4.5

Cancellous

6.5

3.2

(4.5)

6.5

Double drill sleeve

Protection of soft tissue
The double drill sleeve has several functions

Drill sleeve
Use of the corresponding size
Use as handle

DCP & LC-DCP sleeves

The undersurface of the sleeve must be the
same as the plate.

DCP

LC-DCP

DCP & LC-DCP sleeves

Allow dynamic compression on the fracture

neutral

eccentric

DCP & LC-DCP sleeves

The arrow must face towards fracture

The attachments must fit on the handle

Universal drill sleeve

Inter-fragmentary compression is obtained by
correct use of the spring loaded drill sleeve

Used for DCP, LC-DCP and LCP plates

Universal drill sleeve

Spring is activated
Neutral position

Spring is not activated

Eccentric position

Universal drill sleeve

Disassemble to clean spring and tube
Do not lose any item

4 elements

A way to keep everything

together!

Tension device
Will allow compression or distraction of the
fracture.
Compression

Distraction

Tension device used for compression

Plate is fixed to bone.
Device is connected to plate.
Tension (compression) will be obtained by using
the socket wrench

Countersink
To cut the recess of the screw head in the bone.
The size of the tip corresponds with the core
diameter.

Depth gauge
To measure the length of the hole
Depth gauge must be adapted to screw size
Handle is calibrated with increments of 2mm

Disassemble for
maintenance

Tap
To cut the thread of the screw in the bone.
The grooves allow removal of bone debris.

Tap
Remove bone debris with a sharp hook, a K-wire
or by immersing in saline solution.

Screwdriver
Must be adapted to the recess.
Can be used with/without holding sleeve.

In which order do we use the

following instruments?
1. Measuring countersink - tap
2. Countersink tap - measuring
3. Countersink measuring - tap

Wrong procedure
1. Measuring

2. Countersinking
3. Inserting screw

Correct procedure
1.
2.
3.
4.

Countersinking
Measuring
Tapping
Inserting screw

Conclusion
1.

The basic steps for plate and screw

application are always the same: drilling,
countersinking, measuring, tapping and screw
insertion.

2.

A lag screw is applied by drilling a gliding hole.

The size of instruments depend of the size of
the implants.

3.

Dynamic compression is obtained by using

the corresponding drill sleeve.