الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 150 |  |  |
| | | from | 150 | | |
Abstract
Conclusion
1- Before attempting a complicated open reduction and internal fixation, the surgeon must consider his training, his familiarity with the proposed procedure, and his surgical ability.
2- A patient who is fully informed of the rewards and risks of the surgical methods chosen and who is willing to cooperate in the required rehabilitation after surgery. If the patient is not dependable or cooperative, non operative methods of treatment may be a wiser choice.
3- The environment in the operating suite should be superior, the personnel should be familiar with the proposed technique and instrumentation and a complete set of all instrumentation and implants should be readily available and well maintained.
4- Implants should be handled with delicacy, never thrown around in basins or shaken in a basket or immersed in saline. Indeed, implants should be kept in their packages or placed in protective containers until the time of use.
5- Absolute accurate anatomical reduction is essential to provide the transmission of primary weight bearing forces through the column of bone across the fracture site. The goal should be the minimal transmission of force from bone to metal and again from metal to bone at the other side of the fracture.
6- It is a well known fact that for proper fixation by plate and screws an optimum of cortices on either side of the fracture be held firmly by screws through the plate. Small number of screws on either side leads to increase fixation.
7- Every fixation method has its biological advantages and disadvantages. Rigid protocols related to timing and choice of implant should therefore be avoided.
8- Repeated bending back and forth should, however, be avoided because this weakness the plate.
9- Rehabilitation of the patients and the extremity should being immediately, depending on the fracture and soft tissue stability. The patient should be regularly and fully informed about the clinical state, the rate of progress and what is to be expected in the time table of recovery.
However, the patient should be instructed as to his responsibility for maximal functional return of the extremity.