Bone Plating Flashcards
Bond plate constructs counter act these forces
Bending
Rotation
Tension
Compression
Shear
Advantages of bone plating
Allows early return to function
Fewer rechecks
Avoids bandage morbidity
Contraindications of bone plating
Physeal fractures
High-grade open fractures
Disadvantages of bone plating
Disruption of soft tissue/blood supply (by opening/stabilizing
Expense of equipment + large stock needed (overhead cost)
Training/experience required
Materials used for bone plates
316L stainless steel
Titanium alloy
Types of bone plates
Compression
Locking
Specialty
Types of screws
Cortical
Cancellous
Locking
Fully/partially threaded
Modern plates
LC-DCP (dynamic compression plate)
LCP
Methods of reconstruction
Anatomic reconstruction
Biological fixation (uses body to direct healing)
Anatomic reconstruction
Meticulous reconstruction of bone
Allows load-sharing by bone (not as strong of an implant required
Rigid stabilization —> direct bone healing
indications: simple fractures, articular or peri-articular fractures
Biological fixation
Restore joint alignment + limb length
Fragment apposition left to the body
Minimize disruption to fragment site, minimally invasive
Indirect bone healing -> development of primary callus to stabilize
Examples of bridging implants for biological fixation
Plate-rod
Locking plate
Double plate
Application of bone screws
Plate
position
Lag
Plate screw
Hold plate to surface
Position screw
Maintain fragment position
No compression
Lag screw
Fragment reduction
Applies compression across fracture (glide who in near cortex, thread hole in far cortex - slightly smaller than screw shaft)
Perpendicular to fracture
Non-locking plates
Must be in contact with bone
Screws need to be tight
Friction between bone + plate provides stability
Basics of bone plate installation
Minimum of 2 screws/major fragment
3-4 ideal
Plate length ~ bone
Types of plating
Compression
Neutralization
Bridging
Compression plating
Transverse fractures
Anatomic reconstruction
Compression to enhance stability
Plate on “tension surface” + contoured
Neutralization plating
Anatomic reconstruction; bone shares load/protects implants
Oblique fractures - Cerclage wire/lag screw before plating
Bridging plating
Biological fixation
Bone doesn’t share load
Maintain bone length/joint alignment
Examples of bridging plates
Dynamic compression plats
Limb lengthening plates
Plate/rod constructs
Locking plates
Indications for bridging plates
Comminuted diaphyseal fractures
Mal-union or angular limb deformity
Locking plates
Screw interlocks with plate (threading on screw hea)
Acts as single-beam construct
Require plate-bone contact
Little tolerance for inaccurate screw placement —> use drill guide
Reduce fracture BEFORE placing plate
CANNOT move fragment after locking screw placed
Advantages of locking plates
Do not need to contour to bone as much
Can place monocortical screws (bicortical preferred)
Less likely to fail in weak bone
Disadvantages of locking plates
Expensive
Screwed inserted at fixed angle
May not work for all fractures (small fracture gap)
Locking plate systems
LCP - locking compression plate (compression or locking screw)
SOP - String-of-pearls - contouring with 6 deg of freedom, standard cortical screws
Post-op care with bone plating
Early return to function - preserve joint/soft tissues
Restrict activity until union
Monitor by radiography (healing/failure/complications)
Bone plating complications
Infection
Delayed healing/non-union
Implant failure/loosening
Stress protection (implant too strong to facilitate healing —> osteopenia)
Reasons for implant complications
Improper selection and/or application
Disruption of soft tissue/blood supply
Break in sterile technique
Inadequate postoperative restriction
