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Plate & Screws

Plates and Screws in Orthopedic Fixation

Plates and screws are among the most widely used devices in orthopedic surgery for the fixation of fractures, osteotomies, and joint reconstructions. They provide rigid internal fixation, ensuring stability, accurate alignment, and early mobilization of the affected limb. Together, they form a cornerstone of modern fracture management, allowing bones to heal in their correct anatomical position while enabling patients to regain function more quickly than traditional non-surgical methods.

Historical Background

The concept of using metal plates and screws for fracture fixation dates back to the late 19th and early 20th centuries. Early plates were simple flat pieces of metal applied externally, but with poor results due to infection and instability. With the development of aseptic surgical techniques, stainless steel alloys, and biomechanical understanding of fracture healing, the modern plating system evolved. The AO Foundation (Arbeitsgemeinschaft für Osteosynthesefragen), founded in Switzerland in 1958, played a major role in standardizing plating techniques, promoting research, and improving implant design.

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Structure and Materials

1. Plates

  • Flat or contoured metallic devices that are fixed to the outer surface of bones.
  • Available in different shapes, thicknesses, and lengths depending on the bone and fracture type.
  • Made of stainless steel or titanium alloys, both of which are strong, biocompatible, and corrosion-resistant.

2. Screws

  • Cortical screws: Smaller thread pitch, designed for dense cortical bone.
  • Cancellous screws: Larger thread pitch, suitable for spongy cancellous bone.
  • Locking screws: Lock into the plate holes, creating an angular stable construct.
  • Lag screws: Provide interfragmentary compression across a fracture.

Types of Plates

Different plating systems are designed to address specific biomechanical needs:

1. Conventional Plates

  • Rely on friction between plate and bone.
  • Screws compress the plate against the bone surface.

2. Dynamic Compression Plates (DCP)

  • Specially designed holes allow screws to generate compression across the fracture line, promoting stability and healing.

3. Locking Compression Plates (LCP)

  • Use locking screws that fix into the plate, creating a fixed-angle device.
  • Particularly useful in osteoporotic bone or comminuted fractures.

4. Buttress Plates

  • Prevent collapse of bone fragments, often used in periarticular fractures (near joints).

5. Reconstruction Plates

  • Can be contoured easily to fit irregular bone surfaces, such as the pelvis.

6. Specialized Plates

  • Designed for specific anatomical regions, e.g., distal radius plates, proximal humerus plates, tibial plateau plates.

Principles of Plate and Screw Fixation

The choice of plate and screw system depends on the fracture pattern, bone involved, and desired stability. Key biomechanical principles include:

  • Anatomical Reduction: Restoring normal alignment and joint congruency.
  • Stable Fixation: Achieved by compression, bridging, or buttressing techniques.
  • Preservation of Blood Supply: Modern plating emphasizes minimal periosteal stripping to promote healing.
  • Early Mobilization: Stable fixation allows the patient to begin movement and rehabilitation early.

Surgical Technique

  • Exposure – The fracture site is exposed through careful surgical dissection.
  • Reduction – Bone fragments are aligned either manually or with instruments.
  • Plate Application – The plate is positioned over the fracture and contoured if necessary.
  • Screw Insertion – Screws are placed in sequence, either compressing fragments or locking into the plate.
  • Closure and Immobilization – Wound closed; sometimes an external splint is used temporarily.

Advantages of Plate and Screw Fixation

  • Provides rigid and stable fixation.
  • Allows accurate anatomical reduction.
  • Enables early mobilization, reducing joint stiffness and muscle wasting.
  • Suitable for complex and periarticular fractures.
  • Widely available and versatile.

Limitations and Disadvantages

  • Requires open surgery, which may damage soft tissues and blood supply.
  • Higher risk of infection compared to non-surgical methods.
  • May lead to stress shielding (reduced bone loading, causing bone weakening).
  • Hardware prominence can cause discomfort.
  • Implant removal may be necessary if complications arise.

Complications

Potential complications include:

  • Infection at the surgical site.
  • Implant failure (plate breakage, screw loosening).
  • Non-union or delayed union if healing is impaired.
  • Malunion if bones heal in poor alignment.
  • Nerve or vessel injury during screw insertion.
  • Allergic reaction (rare, usually to nickel in stainless steel).

Rehabilitation

Rehabilitation is essential after plate and screw fixation. Early joint mobilization is encouraged to prevent stiffness. Weight-bearing is allowed gradually, depending on fracture stability and healing progress. Physiotherapy focuses on restoring strength, flexibility, and function.

Conclusion

Plates and screws represent one of the most effective and versatile methods of internal fixation in orthopedic surgery. They provide rigid stabilization, ensure precise bone alignment, and promote faster recovery by allowing early mobilization. Despite certain risks and limitations, advances in implant design and surgical techniques have made plate and screw fixation safer and more successful. Their role in managing complex, unstable, and periarticular fractures remains indispensable, making them a cornerstone of modern orthopedic trauma care.

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