Locking Plates: The Current Concepts and Advantages

Posted by GWS SURGICALS LLP on December 19th, 2020

Fractures are old problems and their management criteria has overgone a paradigm shift in the last few years. Generally, the ideal process for treating fractures was anatomic reduction using a dynamic compression plate, but things have changes since the arrival of locking plates. In comparison with traditional compression plating methods, the ‘orthopaedic locking plates’ have gained more preferences in case of highly crushed fractures, osteoporotic fractures, and metadiaphyseal elements. The Locking plate manufacturers have surely seen a raise in sales more than the people dealing in compression plates as locking plates have a defined and illustrious clinical use.

Why Locking plate methods?

While using the compression plating methods, bone healing occurs only when there is absolute stability. The Orthopaedic locking plate plays its part as an internal fixator with multiple anchor points. These kinds of medical equipment have a fixed angle and they convert the axial loads to compressive forces in the fractured area. Due to the same, the Gap length and strain is minimized. There is a proved theory as well that demonstrates that anatomic reduction is not a compulsory requirement and if a tolerable strain of 2-10% can promote secondary bone healing. When biologically friendly surgical methods are combined with the locking plate methods, callus formation also takes place.

The factors that affect the perfect functionality of a locking plate are:

•         Screw placement
•         Screw choice
•         The length of the plate
•         The distance from bone

And many more.

The Advantages of Locking Plates

1.  Locking plate and screw systems have distinct advantages over the traditional systems. The conventional plate system demands the fact that the underlying bone precisely adapts to the plate and there should be an intimate contact. The locking plates function well without this need for adaptation as it is unnecessary for the bone to adapt to the locking plate. All segments do not need to be compressed to the bone, in order to stabilize them.
2. In conventional plates, the systems disturb the underlying cortical bone perfusion due to the cortical bone compression against the surface of the plate. Locking plates is the opposite, it does not majorly disrupt the same.
3. It has been seen in many cases over the years that when a screw is loosened, there are inflammatory complications in a patient which also initiate incidents of infection. If a single screw is losing its tightness, all screws would have to be loosened from their bony insertions which is indeed a painful process. The locking plates offer a major advantage here, that their screws would not loosen from the plate. For example, till a bone graft is in its phase of combination and healing, the screws inserted will not be loosened during that phase, resulting in un-disturbed healing progress.
4. The locking plate / screw systems offer more stable fixation, rather than the traditional systems.

Conclusion

Do you know who is the earliest ancestor of the locking plates? It is the Monocortical fixator! This instrument was enunciated by Carl Hansman in 1886 and its finalized form was presented to the world by Paul Reinhold in 1931 in France. We have now come a long way since then and hope to travel more successful roads in the plate’s direction in the upcoming years!