plates-form and function
DESCRIPTION
AO principlesTRANSCRIPT
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Pre Basic Course
Plates - form and function
Dr Sudarshan Bhandary
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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
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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
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Plate : Form
• DCP• Reconstruction plate• Semitubular - 1/3rd Tubular Plate• LC-DCP• PC-FIX• LCP• LISS
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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
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• 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
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• 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
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Technique of application3 drill guides
a) Concentric (Neutral) - Green collar - 0.1 mm offset
b) Eccentric (Load) - Gold collar - 1 mm offset
c) Universal for buttress mode
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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
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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
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Technique of application
• New spring loaded drill guide• Without pressure - Eccentric hole• With pressure - Neutral
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Tubular plates
• 3.5 system - 1/3rd Tubular• 4.5 system - Semitubular • Limited stability• Collared hole
• Lateral malleolus• Distal ulna / Olecranon• Distal humerus
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Reconstruction plates
• Deep notches between holes• Accurate contouring in any
plane
• Pelvis • Acetabulum• Distal humerus• Clavicle• Olecranon
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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
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LCP – Locking Compression Plate
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L C P
• Latest in the evolution• “ Internal fixator ”• Combination of locking
screw with conventional screw
• Extraperiosteal
location of plate
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LCP
• Fixed angle stability• Unicortical fixation
option• Load & neutral position
of screws• Conical screw head• Large diameter
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LISS-Less Invasive Stabilization System
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LISS
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Plate: Function
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Principles of rigid internal fixation with plates
• Neutralization Plate• Compression plate• Buttress Plate• Bridge Plate • Tension Band Plate
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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
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Compression plating
Techniques
• With dynamic compression principle (DCP/LC-DCP)
• With tension devise• By contouring plate• Additional lag screw thro plate
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Compression plating
• Compression through plate
- DC / LC-DC
• Compression with tension devise
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Compression with external devise
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Contouring Plates
• To fit anatomy of bone• Bending pliers• Weakens plate
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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
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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
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THANK YOU