Fractures are one of the most common injuries that people experience, and they can range from simple, non-displaced fractures to complex, comminuted fractures that require surgical intervention. In the past, fracture fixation was often accomplished using traditional plates and screws, but in recent years, locking plates and screws have emerged as a game-changer in fracture management.
Evolution of locking plates and screws
Over the last two decades, the approach to managing fractures with traditional plating techniques has changed significantly. While dynamic compression plates were considered the preferred method for achieving anatomical reduction in many fractures, there has been a shift towards minimally invasive techniques and biologically friendly internal fixation for treating complex fractures.
Locking plates and screws are now widely used for highly comminuted fractures, unstable metadiaphyseal segments, and osteoporotic fractures due to their superior biomechanical properties compared to traditional plates. Therefore, locking plates and screws have established themselves as the clinical standard for certain types of fractures.
Advantages over traditional plates and screws
- Locking plates and screws offer several advantages over traditional plates and screws. One of the most significant benefits is their ability to create a fixed-angle construct that can resist rotational and translational forces. This is achieved by the locking mechanism that is built into the plate and screw system, which ensures that the screw head is securely locked into the plate, preventing any movement between the two.
- Another advantage of locking plates and screws is their ability to provide increased stability in osteoporotic bone. Osteoporotic bone is characterized by reduced bone density and strength, making it more prone to fracture. Traditional plates and screws can be challenging to use in osteoporotic bone, as they may not provide sufficient stability. Locking plates and screws, on the other hand, can provide increased stability by distributing the load more evenly across the bone and reducing the risk of screw pullout.
- Locking plates and screws are also beneficial in complex fracture patterns that involve multiple fragments. In such cases, traditional plates and screws may not provide enough support to stabilize the fracture, and additional fixation methods may be required. Locking plates and screws can provide the necessary stability and support in such complex fractures, allowing for faster healing and better outcomes.
- Another advantage of locking plates and screws is their ability to allow for early weight-bearing and mobilization. Traditional plates and screws may require longer periods of immobilization to allow for proper healing, as they may not provide enough stability to support early weight-bearing. Locking plates and screws, on the other hand, can provide sufficient stability to allow for early weight-bearing and mobilization, which can help speed up the healing process and reduce the risk of complications.
Disadvantages of conventional plates
- Conventional plates have been a standard method for fracture fixation for many years, but they have several disadvantages that can lead to poor outcomes. One major disadvantage is that screws are free to move independently of the plate, which can cause screw loosening over time. When screws loosen prematurely, it can lead to fracture instability, loss of fracture gap reduction, and even bone nonunion.
- Another disadvantage of conventional plates is that the plate-to-bone compression and friction caused by the movement of the plate, screws, and bone can impair blood circulation to the bone. When blood flow is impeded, it can lead to delayed healing, infection, and other complications. Additionally, conventional plates require high screw torque for stability, which may be too much for osteoporotic bone. Osteoporotic bone is characterized by reduced bone density and strength, which can make it challenging to achieve proper fixation with conventional plates. The high screw torque required can lead to screw pullout or even further bone damage.
- These disadvantages of conventional plates have led to the development of newer technologies such as locking plates and screws, which have become the preferred method for many orthopedic surgeons. Locking plates and screws provide increased stability and can distribute the load more evenly across the bone, reducing the risk of screw pullout and other complications.
Common types of locking plates
Most reputable Locking plates serve the following types of hospitals and healthcare facilities.
- Variable angle lock technology is used in the distal radius variable angle and double column locking plate of 2.4mm. It is beneficial for distal radius osteotomies as well as extra and intraarticular fracture treatment.
- A 2.4mm plate with a distal radius buttress type cures difficult extra and intra-articular fractures. They also treat minor bone osteotomies and distal radius problems.
- Clavicle anterior distal plates for both the left and right legs combine plating techniques with modern locking screw technology. These plates include bone plate holes to give angular stability by fixation with locking screws found in the threaded section. A 3.5mm clavicle anterior locking plate is available.
- Many locking manufacturers offer 4.5mm condylar buttress type plates. These are beneficial in the treatment of supracondylar fractures produced by femoral condyle fractures, distal femur malunions, and non-unions. Furthermore, condylar buttress plates provide support for articular fractures in the medial or lateral condyle femur.
Common types of locking screws
Locking screws are an essential component of locking plate systems used in fracture fixation. They are designed to provide greater stability than traditional screws and can be used in various fracture patterns. Here are some of the most common types of locking screws used in orthopedic surgery:
These screws are designed to be inserted into the outer layer of bone, known as the cortex. They have a threaded shaft and a smooth, unthreaded head that locks into the plate, providing a fixed-angle construct. Cortical screws are commonly used in the treatment of long bone fractures, such as those of the femur, tibia, and humerus.
These screws are designed to be inserted into the spongy, cancellous bone found in the interior of bones. They have a wider thread pitch and a larger core diameter than cortical screws, which allows for greater compression and stability in cancellous bone. Cancellous screws are commonly used in the treatment of fractures involving the joints, such as those of the wrist, ankle, and elbow.
These screws have a head that can rotate in multiple directions, allowing for greater flexibility in screw placement. Polyaxial screws are commonly used in the treatment of complex fractures involving multiple fragments or in cases where it is challenging to achieve optimal screw placement.
Periarticular Locking Screws
These screws are designed to be used in the treatment of fractures near joints. They have a specialized head that is shaped to fit the contours of the joint, providing greater stability and support. Periarticular locking screws are commonly used in the treatment of fractures of the knee, ankle, and elbow.
These screws have a hollow core that allows for the insertion of a guide wire, which can help facilitate accurate screw placement. Cannulated screws are commonly used in the treatment of fractures involving small bones, such as those of the hand and foot.
Preferable materials for locking plates
The most commonly used materials for locking plates and screws are titanium and stainless steel. Both materials are biocompatible and have high strength-to-weight ratios. Titanium has a lower modulus of elasticity, which may be beneficial in reducing stress shielding and promoting bone healing. Stainless steel is less expensive and more readily available. Other materials, such as cobalt-chromium and bioabsorbable materials, are also being explored for use in locking plates and screws, but their clinical use is currently limited.
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