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The treatment of displaced metaphyseal fractures with screws and wiring systems.

Within the context of modern fracture fixation, buttress plates have traditionally played an important role in stabilizing both intraarticular and extraarticular displaced metaphyseal fractures. While plating has substantially improved the assurance of union and functional recovery in these fractures, there is some interference with physiologic blood supply to the regions of the fracture and, consequently, to the biological elements of healing. This article outlines alternative methods of treatment for these fractures using screws and wiring systems with little, if any, loss of stability. Patients must be selected carefully and must have large fracture fragments and normal or near normal mineralization of their bones. When screw and wiring methods can be used, there is less tissue dissection and, consequently, less interference with the physiologic fracture healing process.