Orthopaedic Locking Plates

Abstract

Plating long bone fractures is a practice with a long history, evolving from basic techniques to today’s advanced plating systems. Anatomic reduction using dynamic compression plates has traditionally been considered the gold standard for many fractures. However, minimally invasive approaches combined with biologically friendly internal fixation have now become accepted methods for treating complex fractures. Orthopaedic literature has shown advantages when comparing locking plate techniques to traditional compression plating techniques in certain situations. Each system has its own set of advantages and disadvantages.

Non-locking plates have been used for a long time until we recognized their limitations in certain situations, such as intraarticular and periarticular fractures, osteoporotic fractures, highly comminuted fractures, and periprosthetic fractures. The biomechanical properties of locking plates have distinguished them and defined their clinical use compared to traditional plates. A thorough understanding of these properties will assist users in choosing the appropriate construct when faced with a difficult fracture. Compression plating requires absolute stability for bone healing, whereas locking plates function as “internal fixators” with multiple anchor points, similar to external fixators. This type of fixed-angle device converts axial loads across the bone into compressive forces across fracture sites, minimizing gap length and strain. In contrast to conventional DCP, locking plates promote secondary bone healing through increased callus formation. Further promotion of callus formation occurs when biologically friendly surgical approaches are combined with locking plate “internal fixators”.

As the indications for fracture surgery increase, there is now more scope for using such implants. Additionally, as we encounter more difficult metadiaphyseal and osteoporotic fractures, locking plates are gaining importance in orthopaedic fracture fixation. The literature demonstrates low rates of non-union and overall complication rates with locking plates in challenging metaphyseal and diaphyseal fractures. Anatomic reduction of the articular surface remains of paramount importance. Hybrid techniques that combine the benefits of compression plate fixation with the biological and biomechanical advantages of locking plates represent the most advanced evolution in the plating system for fractures. Designs in screws, screw holes, locking mechanisms, and plate morphology, as well as plating techniques are continuously evolving, and many more clinically useful changes are yet to come in the future.