Locked Internal Fixator Plate

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Internal Fixator Plates have been used from very early times to fix the bones internally. The locking plates serve to maintain length, rotation, and angulation at the fracture. Initially, there were Sherman plates, which used self-tapping screws. Then came the Broad, Narrow, and Small plates of AO type. They were used with compression devices to give a rigid internal fixation.

There used to be cortex to cortex union with no visible callus formation. To achieve an anatomical reduction extensive dissection was done. The periosteum was stripped mercilessly. At that time the biological treatment concept was not there. The heavy plates were tightened to fix on the bone. The area under the plate lost its periosteal blood supply and became avascular. The stability was produced by the friction between the undersurface of the plate and bone. The avascular bone corroded and the holes in bones for screws got osteonecrosis and loose hence they failed to hold till union quite often.

There was an incidence of sterile sequestrum formation in the avascular bone. The process of fracture union used to get delayed till they were revascularized by creeping substitution. Till then the limb had to be immobilized causing stiffness, weakness, muscle atrophy, joint stiffness (fracture disease).

Next came Dynamic Compression plates (DCP).  Which due to its special hole pattern produced compression without a compression device and the concept of extra-periosteal plate came. Still, there was the avascular area under the plate. Which was further reduced by Low Contact Dynamic Compression Plate (LCDCP). Here the avascular area under the plate was less. Care was taken to avoid unnecessary periosteal stripping. Hence the union was quicker and better.

With these principles in mind, the DCP and LCDCP reduced the fracture healing time and there was some callus formation. There was consequent early mobilization and less amount of Fracture disease.


https://www.siiora.com/blogs/locked-internal-fixator-plate/




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