Applications Of Bone Plates

Question 1

Fixation of comminuted diaphyseal fracture

Answer 1

Interlocking nail
External fixator
Plate/rod

Challenges: cannot fully reconstruct, no load sharing, bone plate alone weak against bending

Question 2

Plate/rod fixation

Answer 2

Alternative to bridging plate

IM pin + bone plate construct (IM pin increases bending strength)

Question 3

Advantages of plate/rod fixation

Answer 3

Reduced strain on plate (2x)
Increased fatigue life of plate (10x)

Less invasive that reconstruction

Question 4

Plate/rod installation

Answer 4

Insert IM pin (35-40% of medullary cavity - allows room for screws and avoids excessive rigiditiy) - typically normograde insertion

Plate applied to tension surface of bone - proximal + distal bicortical screws, additional screws bi/monocortical (minimum 4 cortices / each side of fracture)

Question 5

Pelvic fractures

Answer 5

Usually at least 3 fractures

Fixation for breaks in weight bearing axis

Question 6

Indication for pelvic fracture fixation

Answer 6

Iliad fracture
Sacroiliac luxation
Articular (acetabular)

Question 7

Pelvic fracture fixation methods

Answer 7

Bone plating (most common - ilial, acetabular fractures)

Lag screw (SI luxation)

Composite techniques (not as common)

Question 8

Peri-articular fractures

Answer 8

Less fixation options due to decreased area
More stringent post-op restrictions
May need adjunct fixation (external coaptation, trans articular fixator)

Question 9

Peri-articular fracture fixation methods

Answer 9

External fixation

Cross-pin fixation + coaptation

Bone plating - locking plate, specialty plate

Question 10

Key considerations for repair of articular fractures

Answer 10

Meticulous anatomic reduction
Absolute stability - rigid fixation
Preserve blood supply
Early/safe mobilization

Question 11

Facilitating rigid fixation of articular fractures

Answer 11

Lag screws
Kirschner wires
Buttress plate/screws

Question 12

When articular fractures cannot be fixed … (severe damage to joint surface)

Answer 12

Arthrodesis: remove cartilage; autogenous graft; rigid fixation/fusion

Amputation

Question 13

Complications associated with articular fractures

Answer 13

Osteoarthritis
Pain, lameness
Mismatch of joint surfaces —-> cartilage damage
Ankylosis

Question 14

Spinal fractures

Answer 14

Usually from high trauma (hit by car, fall, gunshot)

Question 15

Triaging spinal fracture

Answer 15

Immobilize spine

Neuro exam —> no deep pain = grave prognosis

Question 16

Spinal fracture fixation

Answer 16

Conservative: spinal brace, cage rest

Surgical: internal fixation (plates, composite), external fixation