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The use and abuse of locking plates

2009; Elsevier BV; Volume: 23; Issue: 4 Linguagem: Inglês

10.1016/j.mporth.2009.07.002

1877-1335

Paul Szypryt, Daren P. Forward,

Orthopaedic implants and arthroplasty

Abstract The concept of locking plates is now more than 15 years old and represents a clear advance in the management of fractures by internal fixation using plate technology. Fractures in osteoporotic bone, fractures with short metaphyseal segments and fractures treated with biological fixation are all better managed with lockable plates. There are, of course, additional and unique problems that arise from their use. Locking plates evolved through the recognition that in order to get a fracture to heal quickly and satisfactorily it was not always necessary to achieve rigid internal fixation and absolute stability. The biology of the fracture would be better preserved by using low contact implants combined with minimally invasive surgical techniques. These implants also offered the ability to confer angular stability to a fixation construct. In this article we use the term locking plates and lockable plates. Locking plates refer to those plates that have holes that will only accommodate locking head screws and are therefore used to bridge across the fracture like an internal splint or fixator e.g. Less Invasive Stabilisation System (LISS). In contrast, lockable plates refer to implants that can accept either standard screws or locking screws. This hybrid implant can, therefore, be used to produce internal splintage with locking screws or the more traditional compression, buttressing and neutralization when standard techniques are employed. Failure to recognize that a lockable plate does not necessarily need to have locking head screws inserted is discussed as one of the pitfalls in using these implants.