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Table 4

Key attributes to successful fixation (O’Driscoll [4]).

Fixation principles
  1. Fixation in the distal fragment must be maximized.

  2. All fixation in distal fragments should contribute to stability between the distal fragments and the shaft.

Fixation objectives
  1. Every screw in the distal fragments should pass through a plate.

  2. Engage a fragment on the opposite side that is also fixed to a plate.

  3. As many screws as possible should be placed in the distal fragments.

  4. Each screw should be as long as possible.

  5. Each screw should engage as many articular fragments as possible.

  6. The screws in the distal fragments should lock together by interdigitation, creating a fixed-angle structure.

  7. Plates should be applied such that compression is achieved at the supracondylar level for both columns.

  8. Plates must be strong enough and stiff enough to resist breaking or bending before union occurs at the supracondylar level.

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