expert zone

Clinical topic

24
The use of plates for internal fixation gains more and more importance and acceptance due to the introduction of new implants offering the possibility to lock the screw head with the plate. With this new plate generation, different fixation concepts can be considered and in addition the indication for plating is spread out to the diaphyseal segment of bone. For proper application of the implants—and to avoid technical or mechanical complications—a thorough understanding of the basic concepts of fixation, the bone biology and biomechanics, remains of outstanding importance.
Emanuel Gautier

Bridge plating
Refections useful for the adapted use of plates and screws in internal fixation

More or less all implant systems used in internal fixation consist of two main elements—a longitudinal element for the load transfer from one main fragment to the other and a transverse element to assure the coupling of the implant system to bone (Table 1). When comparing internal fixation with intramedullary nails or internal fixation with plates some major differences appear. Using an intramedullary nail for a diaphyseal fracture the mechanical concept is more or less independent from the fracture pattern—simple fracture, wedge fracture, comminuted fracture. In addition, the position of the nail, the length and diameter of the nail as well as the position of the locking bolts are more or less given and standardised by the local anatomy of the broken bone segment as well as the implant design. In contrast to nailing, plating offers two different fixation concepts—splinting and interfragmentary compression. Comminuted fractures are best treated using a splinting technique, because local bone and soft tissue devascularization can be minimized; while in simple fractures the application of interfragmentary compression can be considered as a stabilization tool. Plate position is chosen mainly according to the local anatomy and the surgical