This technique-focused review by Collinge, Gardner, and Crist catalogs the specific ways distal femur locking plates are misapplied and traces each error to its clinical consequence. Using illustrative cases, the authors define the 'Rule of Too's' and provide anatomy-grounded operative tips to prevent malunion and implant failure.
When placing a distal femur locking plate, run through the Rule of Too's before locking your construct: verify coronal alignment with a joint-axis pin parallel to the condyles on true AP, confirm no screw holes cross Blumensaat's line on true lateral, and assess rotation with the cortical step sign — the plate's anatomy works for you only if your positioning is correct first.
This technique-focused review by Collinge, Gardner, and Crist catalogs the specific ways distal femur locking plates are misapplied and traces each error to its clinical consequence. Using illustrative cases, the authors define the 'Rule of Too's' and provide anatomy-grounded operative tips to prevent malunion and implant failure.
When placing a distal femur locking plate, run through the Rule of Too's before locking your construct: verify coronal alignment with a joint-axis pin parallel to the condyles on true AP, confirm no screw holes cross Blumensaat's line on true lateral, and assess rotation with the cortical step sign — the plate's anatomy works for you only if your positioning is correct first.