Fracture fixation: plate

Introduction

• See also: Fracture - internal fixation .
• To stabilize a fracture using a stainless steel bone plate held in place by screws, allowing early pain-free function until healing is complete.
• Several types of plate are available of differing design and strength, eg:
  • Compression plate.
  • Shermann plate.
  • Lane plate.
  • Venables plate.
  • Burns plate.
  • Finger plate.
  • Lengthening plate.
  • 'T, L' plates.

Uses

• → Fractures of long bones where at least two screws (4 cortices) can be accommodated either side of the fracture line.

Advantages

• Compression of the fracture results from simple tightening of the screws, especially when screws are inserted in the "loaded" postition (eccentrically).
• Can be used in a neutralization (non-loaded) or buttress (bone defect) manner also.
• Used with non-self-tapping screws.

• Of uniform dimensions avoiding 'weaker' constrictions of Shermann and Lane plates - very useful.
• Used with self-tapping screws.

• Combines strength of Venables plate and reduced size of Shermann plate to provide a useful implant for most sized breeds.

• Small and lightweight - useful for miniature breeds.

Disadvantages

• Require soft tissue dissection for adequate exposure.
• Can be combined with i/m pins in cases of major bone loss.
• Technique may require second surgery for plate removal.
• Open surgical technique increases risk of avascularity and infection.

• Expensive.

• Relatively weak - only useful for small breeds.

• Weak plate.

• Can be quite heavy in sizes suitable for large breeds.

Preparation

• 15-30 min.

Requirements

Materials required

Minimum equipment

• Same as: Fracture - internal fixation .
• Chosen plate.
• Drill.
• Self-tapping screws (9/64 diameter is suitable for most dogs) - or non-self-tapping screws and appropriate tap.
• Plate benders.
• Depth gauge.
• 2 pairs of bone-holding forceps .
• Periosteal elevators.
• Retractors.

Ideal equipment

• Same as: Fracture - internal fixation .
• Assistant.

Sequelae

Complications

• Same as Fracture: internal fixation .
• Plate screws may work loose and require removal.
• Fractured bones treated with plates are particularly prone to Stress Protection - especially the heavier Venables plates or dynamic compression plates - advisable to remove plates following fracture healing unless patient is old.
• In patients >1 year - plate removal is indicated at 5-14 months post-op.

Prognosis

• Good when correctly applied.

Reasons for treatment failure

• Same as: Fracture - internal fixation .

Sources

Publications

• Recent references from PubMed.
• McGuiness K, Doyle R S & Glyde M R (2009) Use of a lateral tibial head buttress plate to repair a tibial fracture in a labrador retriever. Vet Rec 164 , 300-303 PubMed.
• Hulse D A & Hyman W (1997) Reduction in plate strain by addition of an intramedullary pin. Vet Surg 26 , 451-459.
• Avon D N, Johnson A L & Palmer R H (1995) Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Comp Contin Educ Pract Vet 17 , 35-49.
• Glennon J C & Flanders J A (1994) The effect of long-term bone plate application for fixation of radial fractures in dogs. Vet Surg 23 , 40-47.
• Montavon P M & Pohler O E M (1988) The mini instrument and implant set and its clinical application. Vet Comp Ortho Traum 1 , 44-51.
• Frey A J & Olds R (1981) A new technique for repair of comminuted diaphyseal fractures. Vet Surg 10 , 51-57.