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Locking Plates Advantages & Indications

Locking Plates Advantages & Indications. 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. Locking Plates are an evolution.

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Locking Plates Advantages & Indications

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  1. Locking PlatesAdvantages & Indications

  2. 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

  3. Locking Plates are an evolution. . . . . . of plate fixation

  4. Plate Evolution • DCP • Dynamic Compression Plate • LC-DCP • Limited Contact Dynamic Compression Plate • LCP • Locking Compression Plate

  5. How is a Locking Plate Different? • Conventional plates depend on friction between the screw & bone for stability • Locking plates & screws create fixed angles that do not rely on screw purchase in bone Conventional Screw & Plate Locked Screw & Plate

  6. Conventional vs Locking Plates

  7. When do Locking Plates Work Best? When conventional screw purchase may be poor: Osteopenic bone Metaphyseal areas Periprosthetic fractures Failed fixation (nonunion) Screw strippage

  8. Plate Design Looks familiar: • Same basic construct of plates and screws • Anatomically shaped • Same stainless steel and titanium materials

  9. Plate Design:Combination Hole • “Figure of eight” hole design • Locking screws • Conventional cortex & cancellous screws

  10. Locking Screw Design • 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 compression between plate and bone Locking Screw Cortex Screw

  11. Locking Screw Design • Core design: • Solid and cannulated • Cannulated screws are inserted over guide wires for precise placement

  12. Screw Head Designs • Threaded head: • Locks screw to plate • Conical head: • Can be used instead of locking screws • Smooth underside fits in round holes • Partially threaded -- lags two fragments together • Fully threaded -- pulls bone to plate • Spherical head cortex screw: • Conventional use

  13. Locking Plates and Screws • How do locking screws affect the surgical technique?

  14. Pre Reduced Fracture Loss of Reduction Conventional Plate Fixation

  15. Conventional Plate Fixation

  16. Non Reduced Fracture NoBone Alignment to the Plate Locking Plates & Screws

  17. No Fracture Malalignment Pre Reduced Fracture Locking Plates & Screws

  18. Locking Plates and Screws • Technique Requirements: • Reduction absolutely essential first • Lag before you lock

  19. Original AO Principles • Anatomic reduction • Stable fixation • Preservation of blood supply • Early motion Do the AO Principles still apply?

  20. 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

  21. Locking Plates & Screws 3) Preservation of Blood Supply: • Limited bony contact stabilizes fracture without plate-to-bone compression • Tapered tip allows submuscular plateinsertion, decreasing tissue destruction

  22. Locking Plates & Screws 4) Early Active Pain Free Mobilization: A more stable construct = earlier return to ADL

  23. 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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