The Guidewire
Field Notes · Trauma
soleintell.com
Plate Function · Force Vectors · Lit Gaps
You can't fix what you don't
understand. Start with the deforming forces.
The plate isn't the construct — the force it neutralizes is. Four modes, one job each. Match the failure pattern to the mechanical answer.
01 / Mode
Neutralization
↻ Rotational forces
Lag screw provides compression. Plate protects it from torsion. The plate isn't loaded axially — it's resisting twist.
02 / Mode
Cerclage Compression
⊕ Compression (wiring)
The current term. We don't call it "tension band" anymore — language has moved on, the biomechanics haven't.
03 / Mode
Antiglide
⇄ Shear control
Plate sits as a mechanical block. Stops the fragment from migrating along an oblique fracture line under shear load.
04 / Mode
Buttress
↓ Axial load control
For fractures unstable in compression — not rotation. Construct is load-sharing. Prevents axial collapse at the joint surface.
Lit Gap · Posterior Mall
Is the McDaniel-era data still load-bearing?
- McDaniel (1970s) — <10 fxs in series
- Verhage (2018) — modern reference point
- Where does Gardner's PITFL 42% fit?
- If post-mall is fixed → still need syndesmosis?
Open Question · Approach
Sural nerve in the posterolateral approach.
- Any merit in intentional sacrifice for big trauma exposure?
- What does the literature actually say about post-op sural neuritis rates?
- Decision: avoid, retract, or accept?
Soft Tissue ◐
Hemorrhagic bulla = a FX BLISTER. The dermis is compromised — adjust your timing.
Pearl ★
Posterior malleolar fixation — aim distal screws SUPERIOR so you don't violate the joint.