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Plate Fixation
Kirkland W. Davis, MD, FACR; Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        TERMINOLOGY

        • Definitions

          • Metal plates fixed to bone by screws; designed to immobilize bone during healing process after fracture, osteotomy, arthrodesis, etc.
          • Plate design and materials evolve rapidly
            • e.g., radiolucent carbon fiber-polyetheretherketone (PEEK) hybrid plates now becoming available
          • Cortical plate (a.k.a. conventional or standard plate)
            • Stable fixation achieved by pressing plate onto bone with screws
            • Load transferred to plate by its friction on bone
            • Must contact cortex as much as possible
          • Locked plate
            • Screw head and plate holes are threaded → head engages plate via threads
            • Fixed-angle devices with screws passing into precise location
            • Allows more micromotion at fracture → ↑ healing
            • Advantageous for osteoporotic fractures
            • Does not require plate to contact bone
            • Usually placed with less invasive technique: short incision
            • Attempt fracture reduction with closed techniques and lagging fragments into place with screws: preserves more tissue/blood supply
          • Bridge plating: forms a "bridge" across comminuted fracture, all fixation distant from fracture site
          • Neutralization plating: rigid fixation to eliminate compression, rotation, and bending; often used for comminuted fractures
          • Limited (low) contact dynamic compression (LCDC) plate
            • Dynamic compression (DC): oval holes in plate; screws inserted in far edge of hole (far from fracture) → beveled head contacts beveled plate → screw pushes bone fragment toward fracture site → compression
              • First used in 1965
            • Limited (low) contact (LC): portions of deep surface of plate cut out, ↓ contact area with bone
              • Meant to preserve some periosteal blood supply → ↑ healing and ↓ infection
              • First added to DC plates in 1990
              • Trials have not confirmed benefits of LC
          • Specialty plates
            • 1/3 tubular plate: small cortical plate curved along long axis
              • Used for fixation of narrow tubular bones, such as fibula
              • Also are 1/4 (smaller) and 1/2 (larger) tubular plates: much less commonly used
            • Reconstruction (recon) plate: cortical plates
              • Low stiffness; notched on sides to allow bending along 3 axes, up to 15° along each axis
              • Used for complex anatomy, e.g., pelvis
              • Also clavicle, distal humerus, calcaneus
            • Buttress plate: cortical plate for periarticular fractures
              • Plate wider near joint than over diaphysis
              • Cradles (buttresses) comminuted fragments of epiphysis and metaphysis, where cortex thinner
              • Even though many locking plates shaped similarly, they do not provide buttress function
            • Blade plate: cortical plate
              • End of plate has angled extension that is inserted into bone
              • Greater degree of angular stability
              • Almost always proximal or distal femur
            • Less invasive stabilization system (LISS) plate: locking plate
              • 1st widely available locking plate
              • Only made for distal femur, proximal tibia
              • Standard locking screw design, fixed-angle device
              • Only uses locking screws: holes are all round
            • Dynamic hip screw instrumentation
              • Cancellous lag screw within metal cannula attached to side plate; with weight bearing, screw slides within cannula, resulting in compression at fracture
              • Used for femoral neck and intertrochanteric fractures
              • Largely replaced by cephalomedullary nails in many centers, except for simple intertrochanteric fractures

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • CT Findings

                PATHOLOGY

                • Pertinent Factors Affecting Fracture Healing

                  Selected References

                  1. DeKeyser GJ et al: Locked plating and advanced augmentation techniques in osteoporotic fractures. Orthop Clin North Am. 50(2):159-69, 2019
                  2. Gausden EB et al: Biomechanics of periprosthetic fixation: plates, nails, cables, and allografts. J Orthop Trauma. 33 Suppl 6:S1-4, 2019
                  3. Hake ME et al: Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg. 27(19):e867-75, 2019
                  4. Allen H et al: Orthopaedic fixation devices used in children: a radiologist's guide. Semin Musculoskelet Radiol. 22(1):12-24, 2018
                  5. Augat P et al: Evolution of fracture treatment with bone plates. Injury. 49 Suppl 1:S2-7, 2018
                  6. Hak DJ et al: Evolution of plate design and material composition. Injury. 49 Suppl 1:S8-11, 2018
                  7. Zhang J et al: One-stage external fixation using a locking plate: experience in 116 tibial fractures. Orthopedics. 38(8):494-7, 2015
                  8. Tejwani NC et al: The changing face of orthopaedic trauma: locked plating and minimally invasive techniques. Instr Course Lect. 57:3-9, 2008
                  9. Lee MJ et al: Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics. 27(3):791-803, 2007
                  Related Anatomy
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                  Related Differential Diagnoses
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                  References
                  Tables

                  Tables

                  KEY FACTS

                  • Terminology

                    • Imaging

                      • Pathology

                        TERMINOLOGY

                        • Definitions

                          • Metal plates fixed to bone by screws; designed to immobilize bone during healing process after fracture, osteotomy, arthrodesis, etc.
                          • Plate design and materials evolve rapidly
                            • e.g., radiolucent carbon fiber-polyetheretherketone (PEEK) hybrid plates now becoming available
                          • Cortical plate (a.k.a. conventional or standard plate)
                            • Stable fixation achieved by pressing plate onto bone with screws
                            • Load transferred to plate by its friction on bone
                            • Must contact cortex as much as possible
                          • Locked plate
                            • Screw head and plate holes are threaded → head engages plate via threads
                            • Fixed-angle devices with screws passing into precise location
                            • Allows more micromotion at fracture → ↑ healing
                            • Advantageous for osteoporotic fractures
                            • Does not require plate to contact bone
                            • Usually placed with less invasive technique: short incision
                            • Attempt fracture reduction with closed techniques and lagging fragments into place with screws: preserves more tissue/blood supply
                          • Bridge plating: forms a "bridge" across comminuted fracture, all fixation distant from fracture site
                          • Neutralization plating: rigid fixation to eliminate compression, rotation, and bending; often used for comminuted fractures
                          • Limited (low) contact dynamic compression (LCDC) plate
                            • Dynamic compression (DC): oval holes in plate; screws inserted in far edge of hole (far from fracture) → beveled head contacts beveled plate → screw pushes bone fragment toward fracture site → compression
                              • First used in 1965
                            • Limited (low) contact (LC): portions of deep surface of plate cut out, ↓ contact area with bone
                              • Meant to preserve some periosteal blood supply → ↑ healing and ↓ infection
                              • First added to DC plates in 1990
                              • Trials have not confirmed benefits of LC
                          • Specialty plates
                            • 1/3 tubular plate: small cortical plate curved along long axis
                              • Used for fixation of narrow tubular bones, such as fibula
                              • Also are 1/4 (smaller) and 1/2 (larger) tubular plates: much less commonly used
                            • Reconstruction (recon) plate: cortical plates
                              • Low stiffness; notched on sides to allow bending along 3 axes, up to 15° along each axis
                              • Used for complex anatomy, e.g., pelvis
                              • Also clavicle, distal humerus, calcaneus
                            • Buttress plate: cortical plate for periarticular fractures
                              • Plate wider near joint than over diaphysis
                              • Cradles (buttresses) comminuted fragments of epiphysis and metaphysis, where cortex thinner
                              • Even though many locking plates shaped similarly, they do not provide buttress function
                            • Blade plate: cortical plate
                              • End of plate has angled extension that is inserted into bone
                              • Greater degree of angular stability
                              • Almost always proximal or distal femur
                            • Less invasive stabilization system (LISS) plate: locking plate
                              • 1st widely available locking plate
                              • Only made for distal femur, proximal tibia
                              • Standard locking screw design, fixed-angle device
                              • Only uses locking screws: holes are all round
                            • Dynamic hip screw instrumentation
                              • Cancellous lag screw within metal cannula attached to side plate; with weight bearing, screw slides within cannula, resulting in compression at fracture
                              • Used for femoral neck and intertrochanteric fractures
                              • Largely replaced by cephalomedullary nails in many centers, except for simple intertrochanteric fractures

                        IMAGING

                        • General Features

                          • Imaging Recommendations

                            • Radiographic Findings

                              • CT Findings

                                PATHOLOGY

                                • Pertinent Factors Affecting Fracture Healing

                                  Selected References

                                  1. DeKeyser GJ et al: Locked plating and advanced augmentation techniques in osteoporotic fractures. Orthop Clin North Am. 50(2):159-69, 2019
                                  2. Gausden EB et al: Biomechanics of periprosthetic fixation: plates, nails, cables, and allografts. J Orthop Trauma. 33 Suppl 6:S1-4, 2019
                                  3. Hake ME et al: Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg. 27(19):e867-75, 2019
                                  4. Allen H et al: Orthopaedic fixation devices used in children: a radiologist's guide. Semin Musculoskelet Radiol. 22(1):12-24, 2018
                                  5. Augat P et al: Evolution of fracture treatment with bone plates. Injury. 49 Suppl 1:S2-7, 2018
                                  6. Hak DJ et al: Evolution of plate design and material composition. Injury. 49 Suppl 1:S8-11, 2018
                                  7. Zhang J et al: One-stage external fixation using a locking plate: experience in 116 tibial fractures. Orthopedics. 38(8):494-7, 2015
                                  8. Tejwani NC et al: The changing face of orthopaedic trauma: locked plating and minimally invasive techniques. Instr Course Lect. 57:3-9, 2008
                                  9. Lee MJ et al: Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics. 27(3):791-803, 2007