TS12: CLINICAL EXPERIENCE WITH LOCKING PLATES – A REVIEW OF THE LAST DECADE

Abstract

Since the early nineties clinical experience were gained with locking plates to stabilize long bone fractures. Firstly with a Point Contact Fixator, a device making the step from a conventional plate to an internal fixator, than with pure precontured internal fixators for the periaticular regions or nowadays with plates giving the option for the placement of locking or conventional cortical screws and are so called Locked Compression Plate (LCP). Almost every new development for extraarticular fracture stabilization reflects this development.

Despite today’s broad, worldwide acceptance of the fixation technique, someone should be very clear about the benefits and the underlying concept to avoid failures, complications and unnecessary costs. Clear clinical benefits have been proven in complex fractures of the metaphysis and joints, furthermore the fixation of highly osteoporotic and/or periprosthetic fractures became more reliable. Also the technique of minimally invasive plating – the so-called biological plating –, where the fracture zone is only bridged and therefore the fracture often is not exposed any more, was facilitated with the new internal fixators. However, the process should not be overused, particularly in cases of insufficient surgical experience, because the technical demanding minimally invasive procedures can have detrimental effects on the fracture alignment and therefore on the later outcome. Not to forget the extended use of intraoperative x-ray exposure to control the reduction and implant fixation.

Applying locking plates, the surgeon should never forget that bone healing requires still prerequisites in respect to stability and, of course, of other biological stimuli. This reflects the ongoing discussion, how a simple long bone fracture, should be optimal stabilized with an internal fixator, the amount of bone/implant fixations contacts and the timing for necessary further operations in present of delayed healing. The opportunity to combine both stabilization options – conventional screw and locking screw placement – within one implant needs a clear understanding of the underlying fixation issues and requires a clear teaching concept to avoid unfavorable combination of the different screws.

In this lecture a broad, critical overview about the worldwide impact of locking plates in long bone fracture treatment will be given including proven advantages as well as discussing detected disadvantages using literature evidence and clinical examples.