Screw and plate device in upper femur. This radiograph demonstrates the first stage reconstruction in a patient with severe deformity using a plate and screw device. The weak bone cortex results in poor fixation and eventual failure. Plate and screw constructs should be avoided if possible, or used only for temporary fixation until intramedullary fixation is possible. The thin white arrow demonstrates a problem typically encountered when fixation screws are inserted in to bone affected with FD, i.e. the plate has pulled away from the bone due to loss of screw fixation.