An orthopedic plate is a form of internal fixation used in orthopaedic surgery to hold fractures in place to allow bone healing [1] and to reduce the possibility of nonunion. Most modern plates include bone screws to help the orthopedic plate stay in place.
Prior to the invention of the orthopedic plate, metal wiring was used to solve the issue of bone fractures until about 1850. It was debated when the first use of this technique was actually made. Supposedly, the first use of this metal wiring was by the ancient Greeks. [2] The first recorded use of metal wiring was is 1755 in a French journal. [2] It was not until 1870, a Frenchman by the name of Laurent Berenger-Feraud began writing a book on internal fixation and bone fractures called "Traité de l'immobilisation directe des fragments osseux dans les fractures" (a book on direct immobilization of bone fragments of fractures). [2] All the information proved to be beneficial in medical procedures, however one thing lacked, the antiseptic treatments needed to properly administer these techniques. Joseph Lister, a British assistant surgeon who in 1877 tried his techniques on a patient and showed huge success. Carl Hausmann is credited with making the first successful plate using both nickel sheets and screws and creating a method of removal without reopening the wound site in 1886. [2] The years following focused on better surgical techniques and experimentation with other materials. Metals were the most common material for orthopedic plates, until cytotoxic tests were used to determine biocompatibility of metals put into the patients body post operation.[ citation needed ]
Modern orthopedic plating did not start until the 1950s where Maurice Muller formed AO/ASIF (Association for the study of internal fixation) along with other surgeons to better improve plating techniques. [3] The purpose of the AO were to better understand bone repair, fracture formation and surgical techniques to gain better results in medical applications. [4]
Orthopedic plates are designed based on the bone fracture. While the general design is similar, each plate must be manufactured to not only to reduce the fracture but also fit the contour of the patient's bone. [6]
Protection
Locking plates can be used either to support a locking head screw, or to force bone together at the fracture. Locking head screws can be applied at the fracture, with the orthopedic plate in place to reduce applied force on the bone fracture.
Tension and Compression
Compression plates can be implanted in such a way that it is in tension, forcing the bone together at the fracture. The use of an articulated tension device can also be used to compress the bone together by pulling the compression plate.
Bridging
For fragmentary bone fractures, bridging plates can be used to hold the bone in place when there are no anchor points at the fracture point. Bridging can allow for relative stability along the bone, while not disturbing the bone fragments. [7]
Buttress
Buttress plates, or concave plates, are useful for fractures along concave surfaces. Due to the angle of the bone, the contour of the concave plate aligns with the bone, providing even compressive force along the fracture. [7]
| 1969 | Dynamic compression plate (DCP) |
| 1990 | Limited-contact dynamic compression plate (LC-DCP) |
| 1994 | Less-invasive stabilization system (LISS) |
| 2001 | Locking Compression Plate (LCP) |
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.
A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.
A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.
A dynamic compression plate (DCP) is a metallic plate used in orthopedics for internal fixation of bone, typically after fractures. As the name implies, it is designed to exert dynamic pressure between the bone fragments to be transfixed. Dynamic compression is achieved either by attaching a tension device to a plate or by using a special dynamic compression plate. However, compression plating requires a longer surgical incision to allow insertion of the tension device and the possibility of refracture after the plate is removed. A neutralization plate is used to bridge a comminuted fracture; it also transmits bending or torsional forces from the proximal to the distal fragment. Plates used for buttressing prevent collapse by supporting an area of thin cortex or cancellous bone graft.
Nonunion is permanent failure of healing following a broken bone unless intervention is performed. A fracture with nonunion generally forms a structural resemblance to a fibrous joint, and is therefore often called a "false joint" or pseudoarthrosis. The diagnosis is generally made when there is no healing between two sets of medical imaging, such as X-ray or CT scan. This is generally after 6–8 months.
Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.
A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments.
The femoral neck is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward.
Dynamic hip screw (DHS) or Sliding Screw Fixation is a type of orthopaedic implant designed for fixation of certain types of hip fractures which allows controlled dynamic sliding of the femoral head component along the construct. It is the most commonly used implant for extracapsular fractures of the hip, which are common in older osteoporotic patients. There are 3 components of a dynamic hip screw, including a lag screw (inserted into the neck of the femur), a sideplate and several cortical screws (fixated into the proximal femoral shaft). The idea behind the dynamic compression is that the femoral head component is allowed to move along one plane; since bone responds to dynamic stresses, the native femur may undergo primary healing: cells join along boundaries, resulting in a robust joint requiring no remodeling.
The Rolando fracture is a type of broken finger involving the base of the thumb.
Vertebral fixation is an orthopedic surgical procedure in which two or more vertebrae are anchored to each other through a synthetic "vertebral fixation device", with the aim of reducing vertebral mobility and thus avoiding possible damage to the spinal cord and/or spinal roots.
Epiphysiodesis is a pediatric orthopedic surgery procedure that aims at altering or stopping the bone growth naturally occurring through the growth plate also known as the physeal plate. There are two types of epiphysiodesis: temporary hemiepiphysiodesis and permanent epiphysiodesis. Temporary hemiepiphysiodesis is also known as guided growth surgery or growth modulation surgery. Temporary hemiepiphysiodesis is reversible i.e. the metal implants used to achieve epiphysiodesis can be removed after the desired correction is achieved and the growth plate can thus resume its normal growth and function. In contrast, permanent epiphysiodesis is irreversible and the growth plate function cannot be restored after surgery. Both temporary hemiepiphysiodesis and permanent epiphysiodesis are used to treat a diverse array of pediatric orthopedic disorders but the exact indications for each procedure are different.
Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.
Chauffeur's fracture, also known as Hutchinson fracture, is a type of intraarticular oblique fracture of the radial styloid process in the forearm. The injury is typically caused by compression of the scaphoid bone of the hand against the styloid process of the distal radius. It can be caused by falling onto an outstretched hand. Treatment is often open reduction and internal fixation, which is surgical realignment of the bone fragments and fixation with pins, screws, or plates.
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the mid-twentieth century. An internal fixator may be made of stainless steel, titanium alloy, or cobalt-chrome alloy. or plastics.
Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.
A tension band wire is a form of orthopaedic internal fixation method used to convert distraction forces into compression forces, promoting bone healing.