dj 4213 locking plates advantages & indications 1-11
TRANSCRIPT
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DJ 4213
Locking PlatesAdvantages & Indications
1-11
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DJ 4213
Objectives
• Describe locking plates and how they differ in design from other bone plates
• Identify the advantages of locking plates over other plates
• Become familiar with the indications for use of locking plates
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Locking Plates are an evolution. . .
. . . of plate fixation
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Plate Evolution
• DCP– Dynamic Compression Plate
• LC-DCP– Limited Contact
Dynamic Compression Plate
• LCP– Locking Compression Plate
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How is a Locking Plate Different?
• Conventional plates & screws depend on friction between the screw thread & bone for stability
• Locking plates & screws create fixed angles that do not rely on screw purchase in bone
Conventional Conventional
Screw & PlateScrew & Plate
Locked Locked
Screw & PlateScrew & Plate
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Conventional vs Locking Plates
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When do Locking Plates Work Best?
When conventional screw purchase may be poor:
– Osteopenic bone– Metaphyseal areas – Periprosthetic fractures– Failed fixation/nonunion– Screw strippage
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Plate Design
Looks familiar:– Same basic construct of
plates and screws– Anatomically shaped– Same stainless steel and
titanium materials
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Plate Design:Combination Hole
• “Figure of eight” hole design
• Locking screws
• Conventional cortex & cancellous screws
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• Threaded underside of head – To thread (lock) into plate hole
• Larger core diameter:– Increases strength– Dissipates load over larger area of bone
• Smaller thread pitch:– Threads not used to generate
screw thread purchase in bone
Locking Screw Design
Cortex ScrewLocking Screw
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DJ 4213
Locking Screw Design
• Core design:– Solid and cannulated– Cannulated screws are inserted over guide wires
for precise placement
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Screw Head Designs
• Threaded head:– Locks screw to plate
• Conical head:– Can be used before, or instead of,
locking screws– Partially threaded -- lags two
fragments together – Fully threaded -- pulls bone to plate
• Spherical head cortex screw: – Conventional use
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DJ 4213
Locking Plates and Screws
• How do locking screws affect the surgical technique?
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Conventional Plate Fixation
Pre Reduced Fracture Loss of Reduction
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Conventional Plate Fixation
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Locking Plates & Screws
Non Reduced FractureNo Bone Alignment to the Plate
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DJ 4213
Locking Plates & Screws
Pre Reduced FractureNo Fracture Malalignment
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Variable Angle Plates
• New in locking plate technology– Allows screws to be angled around central
axis of plate hole to match anatomy– First seen in distal radius plates
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Variable Angle Plates• Now part of new Forefoot-Midfoot System• Will be seen in large & small fragment
periarticular plates
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Variable Angle Plates
• VA holes require special drill guides & VA Locking Screws– Spherical rather than straight head– Be careful – look similar
Variable Angle locking screw Standard locking screw
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Locking Plates and Screws
• Technique Requirements:– Reduction essential first– Lag before you lock
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Original AO Principles
• Anatomic reduction
• Stable fixation
• Preservation of blood supply
• Early motion
Do the AO Principles still apply?
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DJ 4213
Locking Plates & Screws
AO Principles
1) Anatomic Reduction: Locked plate design allows lag screw and compression plating techniques
2) Stable Internal Fixation: Locking screws increase stability in osteoporotic and metaphyseal bone
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Locking Plates & Screws
3) Preservation of Blood Supply:– Limited contact stabilizes fracture
without plate-to-bone compression– Tapered tip allows submuscular (percutaneous)
plate insertion, decreasing tissue destruction
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DJ 4213
Locking Plates & Screws
4) Early Active Pain Free Mobilization: A more stable construct = earlier return to ADL
(Activities of Daily Living)
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Summary• Now you should be able to:
– Describe how locking plates are designed and function differently than conventional plates
– Identify the advantages of locking plates for certain fractures
– Know the indications for using locking plates:• Poor quality bone• Metaphyseal fractures• Periprosthetic fractures• Failed fixation (nonunion)• Screw strippage
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