AO Plating Basics

Table  of  Contents  

Plate  Functions  .........................................................................................................................  1  
Compression  .......................................................................................................................................  1  
Protection  ............................................................................................................................................  2  
Buttress/Antiglide  ...........................................................................................................................  2  
Tension  Band  .....................................................................................................................................  2  
Bridging  ...............................................................................................................................................  2  
Plate  Designs  .............................................................................................................................  3  
Limited-­‐Contact  Dynamic  Compression  Plate  (LC-­‐DCP)  .....................................................  3  
One-­‐Third  Tubular  Plates  ..............................................................................................................  3  
Reconstruction  Plates  .....................................................................................................................  3  
Locking  Plates  ....................................................................................................................................  3  
Special  Plates  .....................................................................................................................................  4  
Absolute  Stability  .....................................................................................................................  5  
Compression  Using  LC-­‐DCP  ...........................................................................................................  5  
Compression  by  Overbending  ......................................................................................................  5  
Lag  Screw  and  Protection  Plate  ...................................................................................................  6  
Compression  Using  Tension  Device  ...........................................................................................  6  
 

Plate Functions
• Surgeon  and  way  of  use  determines  plate  function,  not  its  design  
Plate  Function   Biomechanics   Example  
Compression     Produces  compression  at  the  fx  site  to   Transverse  fx  
provide  absolute  stability  
Protection     Neutralizes  bending  and  rotation  forces  to   Oblique  fx  
protect  a  lag  screw  fixation  
Buttress/antiglide   Resists  axial  load  by  applying  force  at  90deg   Lateral  tibial  
to  axis  of  potential  deformity   platea  fx  
Tension  band   Attached  to  the  tension  side  of  a  fx  and   Olecranon    
converts  tensile  force  into  compressive  force  
at  cortex  opposite  implant  
Bridging     Relative  stability  by  fixation  to  the  two  main   Comminuted  fx  
fragments,  achieving  correct  length,  
alignment,  and  rotation  avoiding  fx  site  

Compression
Produces  compression  at  the  fx  site  to  provide  absolute  stability  
Protection
Neutralizes  bending  and  rotation  forces  to  protect  a  lag  screw  fixation  

Buttress/Antiglide
Resists  axial  load  by  applying  force  at  90deg  to  axis  of  potential  deformity  

Tension Band
Attached  to  the  tension  side  of  a  fx  and  converts  tensile  force  into  compressive  force  
at  cortex  opposite  implant  
• Requires  four  criteria  be  met:  
o Fractured  bone  must  be  eccentrically  loaded  
o Plate  must  be  placed  on  tension  (convex)  surface  
o Plate  must  be  able  to  withstand  tensile  forces  
o Opposite  cortex  must  be  able  to  withstand  compressive  force  

 
Bridging
Relative  stability  by  fixation  to  the  two  main  fragments,  achieving  correct  length,  
alignment,  and  rotation  avoiding  fx  site  
• Long  plates  with  few  screws  should  be  used  in  increase  the  lever  arm  and  
distribute  the  bending  forces  
o Plate  >  3x  the  fx  length  in  comminuted  fxs  
o Plate  >  8-­‐10x  the  fx  length  in  simple  fxs  
o Screw:  plate  hole  ratios  of  <0.5  à  long  lever  arm,  decreases  bending  
loads  on  distal  screws  
• Span  of  at  least  2-­‐3  screw  holes  should  be  left  open  over  fx  to  decrease  stress  
concentration  
Plate Designs

Limited-Contact Dynamic Compression Plate (LC-DCP)

• Two  sizes:  3.5mm  and  4.5mm  
o Determined  by  thread  diameter  of  cortex  screws  used  with  plate  
o 3.5  uses  3.5  cortical  screws,  4.0  cancellous  screws  
o 4.5  uses  4.5  cortical  screws,  6.5  cancellous  screws  
• Eccentric  screw  insertion  à  compression  
• Available  in  stainless  steel  or  titanium  
• Undersurface  limits  contact  between  plate  and  bone  à  less  impairment  

of  capillary  network  of  periosteum  

o Even  distribution  of  
stiffness  à  contouring  
easier  

One-Third Tubular Plates

• Available  in  titanium  or  stainless  steel  
• Thickness  1.0mm  à  limited  stability  
• Useful  in  areas  with  minimal  soft  tissue  
covering  (lateral  mall,  olecranon,  distal  ulna)  
• Holes  surrounded  by  small  collar  to  prevent  
spherical  screw  heads  from  penetrating  plate  
• Oval  holes  à  eccentric  screw  placement  for  
compression  
 

Reconstruction Plates
• Deep  notches  on  edge  of  plate  situated  between  
holes  
o Allows  for  accurate  contouring  in  all  
planes  
• 3.5mm  and  4.5mm  plates  
• Not  as  strong  as  LC-­‐DCP,  further  weakened  by  
contouring  
• Oval  holes  to  allow  for  compression  
• Good  for  places  with  complex  3D  geometry  
(pelvis,  acetabulum,  distal  humerus,  distal  tibia,  clavicle)  
 

Locking Plates
• Screw  “locks”  into  plate  
• Does  not  require  plate  to  be  compressed  to  the  bone  for  stability  
• Can  serve  as  internal  fixators  
 o Without  contact  with  periosteum  provides  relative  stability  with  
minimal  damage  to  blood  supply  
• Load  distributed  along  entire  construction  (not  at  a  single  bone-­‐screw  
interface)  
o Failure  with  traditional  plates  often  starts  at  one  screw  and  
propagates-­‐  this  is  avoided  with  locked  plates  
o Particularly  useful  in  osteoporotic  bone  
• Screw-­‐plate  interface  acts  as  a  surrogate  cortex  à  don’t  need  bicortical  
screw  fixation  
• Use  threaded  drill  guide  to  place  locking  screws  
• “Lag  first,  lock  second”  
o Once  a  locking  screw  is  placed  through  a  plate  into  a  fracture  
fragment,  the  plate’s  position  to  that  fragment  is  fixed  and  cannot  be  
changed  
o Once  a  locking  screw  is  placed,  no  additional  conventional  screws  
should  be  inserted  into  this  fragment  and  only  
additional  locking  screws  should  be  placed  
• Locking  compression  plate  (LCP)  
o Has  both  locking  and  nonlocking  capabilities  
(combination  holes)  to  allow  for  compression  
o Can  serve  as  internal  fixator,  provide  any  of  the  5  
biomechanical  functions,  and  can  be  used  as  a  
reduction  tool  
§ Locking  screw  cannot  be  used  a  reduction  tool  (once  a  locking  
screw  is  placed,  the  plate  position  is  locked  
to  that  fragment)  
• Less  invasive  stabilization  
system  (LISS)  
o Can  only  provide  bridging  
function  

Special Plates
• Special  plates  for  specific  
locations  
o Shaped  anatomically  
a. DHS  
b. LCP-­‐DF  distal  femur  
c. LCP  proximal  tibia  
d. LCP  metaphyseal  plate  
e. PHILOS  (proximal  humerus  
internal  locking  system)  
f. LCP  olecranon  
g. LCP  distal  humerus  
h. LCP  distal  radius  
 
Absolute Stability
• Requires  anatomical  reduction  and  interfragmentary  compression  
o Can  be  established  by:  
§ Lag  screws  
§ Axial  compression  plate  
§ Both  
• Compression  must  sufficiently  neutralize  all  forces  (bending,  tension,  shear,  
rotation)  along  the  whole  cross  section  of  fx  
• Four  ways  to  obtain  interfragmentary  compression  with  a  plate:  
o Dynamic  compression  unit  in  a  plate  (LC-­‐DCP)  
o Contouring  (overbending)  plate  
o Lag  screws  through  plate  holes  
o Articulated  tension  device  

Compression Using LC-DCP

• As  described  above  
• Compression  is  lower  than  with  tension  device  
• Have  to  prebend  plate  to  obtain  even  distribution  of  compressive  forces  

Compression by Overbending
• If  straight  plate  applied  to  straight  bone  à  
compressive  force  =  greatest  directly  underneath  
plate  
o Small  gap  2/2  tension  forms  at  far  cortex  
o Prebending  plate  à  compression  of  the  
opposite  cortex  
   
Lag Screw and Protection Plate
• Lag  screw  provides  compression  
• Protection  plate  protects  lag  screw  fixation  from  bending,  shearing,  
rotational  forces  
• Lag  screws  may  be  placed  independently  or  through  plate  

 
Compression Using Tension Device
• Can’t  use  a  lag  screw  for  transverse  or  short  
oblique  fxs-­‐  can  use  a  tension  device  
• Oblique  fxs:  apply  tension  in  a  way  that  the  
spike  is  pressed  into  axilla  formed  by  plate  
and  other  fragment  
o Can  place  lag  screw  after  axial  
compression  has  been  established  
• Transverse  fxs:  essential  to  prebend  plate  
to  prevention  tension  and  a  gap  at  the  
opposite  cortex