Locking Plates

Advantages & Indications

DJ 4213

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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

DJ 4213

Locking Plates are an evolution. . .

. . . of plate fixation
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Plate Evolution
DCP
Dynamic Compression Plate

LC-DCP
Limited Contact
Dynamic Compression Plate

LCP
Locking Compression Plate
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How is a Locking Plate

Different?
Conventional plates &
screws depend on friction
between the screw thread &
bone for stability
Locking plates & screws
create fixed angles that do
not rely on screw purchase
in bone

DJ 4213

Conventional
Screw & Plate

Locked
Screw & Plate

Conventional vs Locking Plates

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When do Locking Plates Work

Best?
When conventional screw purchase may
be poor:
Osteopenic bone
Metaphyseal areas
Periprosthetic fractures
Failed fixation/nonunion
Screw strippage

DJ 4213

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

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Plate Design:
Combination Hole
Figure of eight hole
design
Locking screws
Conventional cortex &
cancellous screws

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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
screw thread purchase in bone
Locking Screw Cortex Screw
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Locking Screw Design

Core design:
Solid and cannulated
Cannulated screws are inserted over guide wires
for precise placement

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Screw Head Designs

Threaded head:
Locks screw to plate

Conical head:
Can be used before, or instead of,
locking screws
Partially threaded -- lags two
fragments together
Fully threaded -- pulls bone to plate

Spherical head cortex screw:

Conventional use
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Locking Plates and Screws

How do locking screws affect
the surgical technique?

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Conventional Plate Fixation

Pre
Loss
Reduced
of Reduction
Fracture

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Conventional Plate Fixation

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Locking Plates & Screws

Reduced
Fracture
NoNon
Bone
Alignment
to the Plate

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Locking Plates & Screws

Pre
Reduced
Fracture
No
Fracture
Malalignment

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Variable Angle Plates

New in locking plate technology
Allows screws to be angled around central
axis of plate hole to match anatomy
First seen in distal radius plates

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Variable Angle Plates

Now part of new Forefoot-Midfoot System
Will be seen in large & small fragment
periarticular plates

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Variable Angle Plates

VA holes require special drill guides & VA
Locking Screws
Spherical rather than straight head
Be careful look similar

Variable Angle locking screw

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Standard locking screw

Locking Plates and Screws

Technique Requirements:
Reduction essential first
Lag before you lock

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Original AO Principles

Anatomic reduction
Stable fixation
Preservation of blood supply
Early motion

Do the AO Principles still apply?

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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

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Locking Plates & Screws

3) Preservation of Blood Supply:
Limited contact stabilizes fracture
without plate-to-bone compression
Tapered tip allows submuscular (percutaneous)
plate insertion, decreasing tissue destruction

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Locking Plates & Screws

4) Early Active Pain Free Mobilization:
A more stable construct = earlier return to ADL
(Activities of Daily Living)

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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:

DJ 4213

Poor quality bone

Metaphyseal fractures
Periprosthetic fractures
Failed fixation (nonunion)
Screw strippage

DJ 4213