Pre Basic Course

Plates - form and function

Dr Sudarshan Bhandary
 Plate : Form and Function

• To understand how changes in the design of

plates has evolved to meet the needs of the
patient
• To understand how you can use a plate in
several different ways to achieve different
types of fixation
 Plate : Form and Function
• Absolute stability challenged by biological
fixation
• Osteosynthesis with plates has a firm place in #
treatment
• Articular #s require stable fixation
• Compromise of cortical blood supply a major
drawback of conventional plating
 Plate : Form

• DCP
• Reconstruction plate
• Semitubular - 1/3rd Tubular Plate
• LC-DCP
• PC-FIX
• LCP
• LISS
 DCP - 3.5 and 4.5

• First introduced in 1969 by Danis

• Revolutionary concept of compression plating
• Featured a new hole designed for axial compression
• Broad 4.5 for Femur & Narrow 4.5 for Humerus &
Tibia
• DCP 3.5 for Forearm, Fibula, Pelvis & Clavicle
• The screw hole in DCP is like a portion of an inclined
& angled cylinder

• When the screw is tightened it results in a movement

of bone fragment in relation to the plate
• Screw holes allow 1mm
compression
• Additional compression with
1 more eccentric screw before
locking first screw

• Oval shape allows 25*

inclination in longitudinal &
7* in transverse plane
 Technique of application
3 drill guides
a) Concentric (Neutral) - Green collar - 0.1 mm offset
b) Eccentric (Load) - Gold collar - 1 mm offset
c) Universal for buttress mode
 Problems with DCP

• Unstable fixation leads to fatigue & failure

• Strict adherence to principles of compression
• Compromised blood supply due to intimate
contact with underlying cortex
• “Refractures” after plate removal
 LC-DCP
• Represents a design change
• Overcome problems with DCP
• Plate footprint reduced
• Minimized kinking at screw holes
• Allows more inclination of screw in
longitudinal plane
 Technique of application
• New spring loaded drill guide
• Without pressure - Eccentric hole
• With pressure - Neutral
 Tubular plates

• 3.5 system - 1/3rd Tubular

• 4.5 system - Semitubular
• Limited stability
• Collared hole

• Lateral malleolus
• Distal ulna / Olecranon
• Distal humerus
 Reconstruction plates

• Deep notches between holes

• Accurate contouring in any
plane

• Pelvis
• Acetabulum
• Distal humerus
• Clavicle
• Olecranon
 New Systems
• Abolish ill effects of plate to bone contact
• Concept of “Internal Fixator”
• PC - FIX = First implant designed
• Self tapping, unicortical, one length screws
• Locking head
LCP – Locking Compression Plate
 LCP
• Latest in the evolution
• “ Internal fixator ”
• Combination of locking
screw with conventional
screw
• Extraperiosteal
location of plate
 LCP
• Fixed angle stability
• Unicortical fixation
option
• Load & neutral position
of screws
• Conical screw head
• Large diameter
LISS-Less Invasive Stabilization System
LISS
Plate: Function
Principles of rigid internal fixation with plates

• Neutralization Plate
• Compression plate
• Buttress Plate
• Bridge Plate
• Tension Band Plate
 Neutralisation Plate

• Used with lag screws , plate is

protective
• Neutralises the weight bearing forces
to protect the lag screws from axial
loading
• Lag screw generates forces of 3000 N
 Compression plating
Techniques

• With dynamic compression principle

(DCP/LC-DCP)
• With tension devise
• By contouring plate
• Additional lag screw thro plate
 Compression plating
• Compression through plate
- DC / LC-DC

• Compression with tension

devise
Compression with external devise
 Contouring Plates
• To fit anatomy of bone
• Bending pliers
• Weakens plate
 Buttress Plate
• Used when the fracture will only displace in one
direction.
• Only useful in metaphyseal fractures
• Applied so as to resist one deforming force
 AO Organisation

☻ Philosophies and techniques of treatment will

change with time

☻ The philosophy that we exist to improve the

care given to our patients will last forever
THANK YOU