| The various bones and fracture positions dictate the | | | | supply is provided by the periosteal bone lining. The |
| different types of plate available. The DCP or | | | | periosteum should be preserved and not stripped |
| dynamic compression plate and the screw holes allow | | | | away during the operation or healing could be delayed |
| compression of the fracture site to be applied as the | | | | from reduced vascular supply. Unstable comminuted |
| screws are tightened up in the angled screw holes. | | | | fractures are more difficult to fix and bridge plates |
| Small plates are used to fix the lateral malleolus of | | | | are used to fix the two main parts and keep the |
| the ankle and the wrist end of the ulna forearm bone | | | | important aspects of the bone in line, the rotation, |
| and for this job they are often very thin at an easily | | | | alignment and length of the bones. However this |
| mouldable one millimetre. Other plates have been | | | | form of weaker fixation cannot tolerate any |
| designed for use in fractures close to joints and | | | | significant level of load. |
| these have reduced device size and thickness and | | | | The Less Invasive Surgical Stabilisation plating system |
| added options for the flexibility in fixation required. | | | | (LISS) is a modern fixation system which limits the |
| Fractures of the upper femur are fixed by using | | | | contact between the metal and the bone, lowering |
| plates with a 95 degree angle so that the mechanical | | | | the risks of the blood supply in the damaged area |
| axis of the upper femur can be restored at this | | | | becoming compromised. These designs are more |
| angle. Inserting this kind of fixation requires that the | | | | mouldable to the bony contours and have the ability |
| surgeon thinks in three dimensions as are all must be | | | | to apply locking screws, allowing these designs to |
| correctly aligned to restore normal anatomy. | | | | keep the desired bony alignment whilst simultaneously |
| Reconstruction plates are less thick than dynamic | | | | managing to resist significant forces during the period |
| compression plates and can be contoured in three | | | | of healing. Choice of these newer designs is indicated |
| dimensions for the acetabulum and pelvis. Fractures | | | | in managing fractures of the end of bones such as |
| close to or next to prostheses such as hip | | | | the radius, humerus and femur. |
| replacements or knee replacements are fixed with | | | | Conventional plating techniques are adequate to fix |
| larger plates with the addition of cerclage wires. | | | | fractures where access to the areas is easy and in |
| High levels of fracture stability can be provided by | | | | cases where the fractures are of a stable type, |
| compression of the fragments and a good | | | | incorporating fractures of bony shafts such as the |
| restoration of anatomical alignment by the fixation. If | | | | ulna, humerus and radius. With osteoporotic bone and |
| firmly stabilised and without any fragment gap then | | | | difficult fixation options the locking systems will be |
| the fracture will heal by primary healing. Absorption of | | | | more appropriate. As they are much more expensive |
| the dead bone at the site of fracture occurs by the | | | | than the conventional systems they are not yet the |
| action of osteoclasts, with blood vessels growing into | | | | default choice in all cases but look likely to be more |
| the region and then bone producing cells proliferating. | | | | widely used as the cost comes down. They may well |
| Disruption of the blood supply by the plate can | | | | be cost effective if cases of malunion which require |
| produce some osteoporosis under the plate, leading | | | | revision are taken into account. |
| to reduced bone strength from this and the screw | | | | Nails |
| holes once the plate is removed, necessitating careful | | | | It was in the 1930s that Kuntscher refined the |
| decisions about the amounts of force to be applied | | | | intramedullary nailing technique which then became |
| to the area. | | | | the treatment of choice for shaft fractures of the |
| Internal fixation with a plate involves opening up the | | | | femur. Humeral and tibial fractures as well as femoral |
| fracture site and removing the blood clot, reducing | | | | breaks nearer the bone ends were the next |
| the fragments to an anatomically acceptable | | | | progression. Early joint movement and weight bearing |
| alignment. A fracture interrupts the blood supply | | | | walking is allowed by this. |
| across and around a fracture and the remaining blood | | | | |