Bone Plating

Question 1

Bond plate constructs counter act these forces

Answer 1

Bending
Rotation
Tension
Compression
Shear

Question 2

Advantages of bone plating

Answer 2

Allows early return to function
Fewer rechecks
Avoids bandage morbidity

Question 3

Contraindications of bone plating

Answer 3

Physeal fractures
High-grade open fractures

Question 4

Disadvantages of bone plating

Answer 4

Disruption of soft tissue/blood supply (by opening/stabilizing

Expense of equipment + large stock needed (overhead cost)

Training/experience required

Question 5

Materials used for bone plates

Answer 5

316L stainless steel
Titanium alloy

Question 6

Types of bone plates

Answer 6

Compression
Locking
Specialty

Question 7

Types of screws

Answer 7

Cortical
Cancellous
Locking

Fully/partially threaded

Question 8

Modern plates

Answer 8

LC-DCP (dynamic compression plate)
LCP

Question 9

Methods of reconstruction

Answer 9

Anatomic reconstruction

Biological fixation (uses body to direct healing)

Question 10

Anatomic reconstruction

Answer 10

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

Question 11

Biological fixation

Answer 11

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

Question 12

Examples of bridging implants for biological fixation

Answer 12

Plate-rod
Locking plate
Double plate

Question 13

Application of bone screws

Answer 13

Plate
position
Lag

Question 14

Plate screw

Answer 14

Hold plate to surface

Question 15

Position screw

Answer 15

Maintain fragment position
No compression

Question 16

Lag screw

Answer 16

Fragment reduction

Applies compression across fracture (glide who in near cortex, thread hole in far cortex - slightly smaller than screw shaft)

Perpendicular to fracture

Question 17

Non-locking plates

Answer 17

Must be in contact with bone
Screws need to be tight

Friction between bone + plate provides stability

Question 18

Basics of bone plate installation

Answer 18

Minimum of 2 screws/major fragment
3-4 ideal

Plate length ~ bone

Question 19

Types of plating

Answer 19

Compression
Neutralization
Bridging

Question 20

Compression plating

Answer 20

Transverse fractures

Anatomic reconstruction

Compression to enhance stability

Plate on “tension surface” + contoured

Question 21

Neutralization plating

Answer 21

Anatomic reconstruction; bone shares load/protects implants

Oblique fractures - Cerclage wire/lag screw before plating

Question 22

Bridging plating

Answer 22

Biological fixation
Bone doesn’t share load
Maintain bone length/joint alignment

Question 23

Examples of bridging plates

Answer 23

Dynamic compression plats
Limb lengthening plates
Plate/rod constructs
Locking plates

Question 24

Indications for bridging plates

Answer 24

Comminuted diaphyseal fractures
Mal-union or angular limb deformity

Question 25

Locking plates

Answer 25

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

Question 26

Advantages of locking plates

Answer 26

Do not need to contour to bone as much Can place monocortical screws (bicortical preferred) Less likely to fail in weak bone

Question 27

Disadvantages of locking plates

Answer 27

Expensive Screwed inserted at fixed angle May not work for all fractures (small fracture gap)

Question 28

Locking plate systems

Answer 28

LCP - locking compression plate (compression or locking screw) SOP - String-of-pearls - contouring with 6 deg of freedom, standard cortical screws

Question 29

Post-op care with bone plating

Answer 29

Early return to function - preserve joint/soft tissues Restrict activity until union Monitor by radiography (healing/failure/complications)

Question 30

Bone plating complications

Answer 30

Infection Delayed healing/non-union Implant failure/loosening Stress protection (implant too strong to facilitate healing —> osteopenia)

Question 31

Reasons for implant complications

Answer 31

Improper selection and/or application Disruption of soft tissue/blood supply Break in sterile technique Inadequate postoperative restriction