Elsevier

Injury

Volume 40, Issue 7, July 2009, Pages 683-691
Injury

Review
Indications and limitations of locked plating

https://doi.org/10.1016/j.injury.2009.01.003Get rights and content

Abstract

The goal of fracture fixation is to achieve bone healing and restore the function of the injured limb in the shortest possible time without compromising safety. Newer technologies such as the locking compression plate (LCP) and its derivatives are valuable additions to the orthopaedic traumatologist's armamentarium. As with any emerging technology, the indications will be extended until a threshold is reached and the limitations of the technology are seen. It is vital that surgeons involved in fracture care are aware of when locked plating is superior to other methods and also when they should use another treatment modality.

This paper reviews the use of locked plating as a fixation method. Five topics covered in this review are: a historical perspective on locked plating, general indications, specific modes and techniques, patterns of failure, and an anatomical overview of current indications for locked plating.

Section snippets

Introduction and focused historic perspectives

The ultimate goal of the orthopaedic trauma surgeon is to restore function via undisturbed bone healing – respecting the soft tissues – which allows safe and expeditious rehabilitation of the patient. To achieve optimal results the knowledge of patient and fracture personalities as well as a clear, realistic understanding of personal, technical, and biological limitations is mandatory. Locked plating is a more recent technique available for fracture fixation and understanding the principles and

General indications

Orthopaedic trauma experts consider using locking head screws in 5–25% of all fractures treated with plate osteosynthesis. Most of the straightforward upper limb diaphyseal fractures with good bone stock should be treated with absolute stability principles using conventional compression plating. The decision to use locked plates should be based on careful evaluation considering the anatomical region, the fracture pattern, soft tissues, bone quality and existing implants.

Conventional plating with absolute stability

The LCP does not preclude the use of conventional plating principles due to the combination hole. Absolute stability is obtainable by using the outer aspect of the combination hole in exactly the same fashion as with a conventional compression plate. After reduction and compression by this means, the remaining holes can then be filled with either conventional screws or locking screws (Fig. 2). The use of locking screws to fill the remainder of the plate is particularly useful in osteoporotic

Techniques, pitfalls and patterns of failure

Fracture fixation with the LCP usually involves the most complex fractures and, attempted in percutaneous fashion can predictably lead to many implant and technique specific complications. Most of these complications and failures can be prevented with careful planning, application of the principles and good knowledge of the indications and the limitations of the implants and the technique.

Locking head screws are designed to thread into the locking hole at a fixed angle. Variation of the screw

Proximal humerus

Proximal humeral fractures that require operative treatment are the more displaced and comminuted types. In addition to the increased fracture severity, fracture treatment is made more difficult due to the patient population being more elderly and osteoporotic. The use of angle stable implants for the proximal humerus with variable screw trajectory serves to increase stability of the fracture construct7, 37, 39, 45 and may help to reduce collapse of the fracture. The use of locked plating has

Conclusions and future directions

The availability of locked plates potentially expands the indication for plating and can improve the quality of the fixation of complex fractures. Locked plating has revolutionised plate fixation in the standard areas of plating and does provide superior fixation in anatomical areas which were historically difficult or complicated areas for plating, such as comminuted articular and metaphyseal fractures. The frequency of using these systems is expected to increase with the current epidemic of

Conflict of interest

The authors have no financial conflict of interest.

Acknowledgement

The authors thank Dr. Tim Pollitt for reviewing the manuscript.

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