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Plate Fixation
Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        TERMINOLOGY

        • Definitions

          • Metallic plates fixed to bone by screws; designed to immobilize bone during healing process; technology is ever evolving
          • Blade plates
            • End of plate has angled extension that is inserted into bone
            • Provides rigid fixation when plate cannot contact entire cortex, such as condylar regions of long bones
          • Bridging plates: Crosses comminuted segment
          • Buttress plates and T plates
            • 1 end has increased width either through orthogonal bar (T) or some form of flare
            • Placed at sites of thin cortical bone, usually at metaphysis; often used for periarticular fractures
            • Used when deforming forces across fracture are axial/compression: Distal radius, proximal tibia
              • Also proximal & distal humerus
          • Compression plating
            • Specific type of plate with ovoid screw holes
              • Plates can be applied so they do not apply compression forces
            • Dynamic compression plating: Ovoid holes are oriented so that as screw is tightened, both screw and attached bone are drawn to plate center, resulting in compression
            • Primarily for treatment of diaphyseal fractures
            • Low contact compression plate: Minimizes contact with periosteum lessening disruption of blood flow
          • 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
          • Locking plate: Screw heads threaded to lock with threaded screw hole; joins screws and plate to create single unit; prevents failure due to screws backing out
            • Does not require close application to bone surface
            • May only need unicortical screw fixation
            • ↓ soft tissue damage, ↓ disruption of blood supply
            • Concerns raised that construct is too rigid, inhibiting slight motion required to induce healing
          • Neutralization plating
            • Refers to manner in which plate is applied to bone
            • Neutralizes external forces, such as rotation and bending so they are not transmitted to fracture
            • Used to treat comminuted fractures where compression not desirable and comminuted fragments are unable to resist those forces, resulting in collapse of reduction
          • 1/3 tubular plates: 1/3 circumference of cylinder
            • Used for fixation of thin tubular bones, such as metatarsals, ulna, fibula
          • Reconstruction (recon) plates
            • Low stiffness; notched to allow bending along 3 axes, up to 15° along each axis
            • Can be cut to size and bent to contour along desired shape
            • Fixation of osseous structures with complex anatomy, such as pelvic and acetabular fractures or osteotomies, also distal humerus, clavicle, calcaneus

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              PATHOLOGY

              • Pertinent Factors Affecting Fracture Healing

                Selected References

                1. Zhang J et al: One-stage external fixation using a locking plate: experience in 116 tibial fractures. Orthopedics. 38(8):494-7, 2015
                2. Tejwani NC et al: The changing face of orthopaedic trauma: locked plating and minimally invasive techniques. Instr Course Lect. 57:3-9, 2008
                3. 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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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Imaging

                    • Pathology

                      TERMINOLOGY

                      • Definitions

                        • Metallic plates fixed to bone by screws; designed to immobilize bone during healing process; technology is ever evolving
                        • Blade plates
                          • End of plate has angled extension that is inserted into bone
                          • Provides rigid fixation when plate cannot contact entire cortex, such as condylar regions of long bones
                        • Bridging plates: Crosses comminuted segment
                        • Buttress plates and T plates
                          • 1 end has increased width either through orthogonal bar (T) or some form of flare
                          • Placed at sites of thin cortical bone, usually at metaphysis; often used for periarticular fractures
                          • Used when deforming forces across fracture are axial/compression: Distal radius, proximal tibia
                            • Also proximal & distal humerus
                        • Compression plating
                          • Specific type of plate with ovoid screw holes
                            • Plates can be applied so they do not apply compression forces
                          • Dynamic compression plating: Ovoid holes are oriented so that as screw is tightened, both screw and attached bone are drawn to plate center, resulting in compression
                          • Primarily for treatment of diaphyseal fractures
                          • Low contact compression plate: Minimizes contact with periosteum lessening disruption of blood flow
                        • 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
                        • Locking plate: Screw heads threaded to lock with threaded screw hole; joins screws and plate to create single unit; prevents failure due to screws backing out
                          • Does not require close application to bone surface
                          • May only need unicortical screw fixation
                          • ↓ soft tissue damage, ↓ disruption of blood supply
                          • Concerns raised that construct is too rigid, inhibiting slight motion required to induce healing
                        • Neutralization plating
                          • Refers to manner in which plate is applied to bone
                          • Neutralizes external forces, such as rotation and bending so they are not transmitted to fracture
                          • Used to treat comminuted fractures where compression not desirable and comminuted fragments are unable to resist those forces, resulting in collapse of reduction
                        • 1/3 tubular plates: 1/3 circumference of cylinder
                          • Used for fixation of thin tubular bones, such as metatarsals, ulna, fibula
                        • Reconstruction (recon) plates
                          • Low stiffness; notched to allow bending along 3 axes, up to 15° along each axis
                          • Can be cut to size and bent to contour along desired shape
                          • Fixation of osseous structures with complex anatomy, such as pelvic and acetabular fractures or osteotomies, also distal humerus, clavicle, calcaneus

                      IMAGING

                      • General Features

                        • Imaging Recommendations

                          • Radiographic Findings

                            PATHOLOGY

                            • Pertinent Factors Affecting Fracture Healing

                              Selected References

                              1. Zhang J et al: One-stage external fixation using a locking plate: experience in 116 tibial fractures. Orthopedics. 38(8):494-7, 2015
                              2. Tejwani NC et al: The changing face of orthopaedic trauma: locked plating and minimally invasive techniques. Instr Course Lect. 57:3-9, 2008
                              3. 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