Use of Locking Plates in Orthopaedic Trauma Surgery.

Abstract

Locking plate constructs have a potential role whenever plating is considered for the treatment of fractures. Deciding when locked plating provides advantages that justify its increased costs over conventional nonlocking constructs remains a challenge. When locked plating is utilized, optimizing the precise number and location of locking screws and the utility of combining nonlocking screws with locking screws are additional considerations. Locking plate constructs offer advantages over nonlocking constructs for the treatment of comminuted metaphyseal fractures. These fractures demand a fixed-angle construct to avoid loss of reduction1. Partially because of their ease of application, locking plates have essentially supplanted other fixed-angle constructs such as the blade plate and dynamic condylar screw. The application of locking constructs to other metaphyseal fractures for which satisfactory fixed-angle alternatives do not exist, such as the proximal and distal parts of the tibia, proximal part of the humerus, and distal part of the radius (the latter of which are beyond the scope of this review), are rational extensions of locking plate technology. The primary advantage of locking plates is that they can be effectively used in situations in which bone quality precludes satisfactory fixation with nonlocking screws. Nonlocking screw constructs require good bone quality in order to be effective. The stability of nonlocking constructs depends on the …