Bone plates are used to stabilize fractures and allow healing. There are several types of plates that serve different purposes: protection plates neutralize forces to protect fractures fixed with lag screws, compression plates apply tension to achieve compression at the fracture site, bridge plates span multifragmentary fractures without disturbing the fracture, and buttress/antiglide plates resist forces perpendicular to the axis of deformity. More recently, locking plates have been developed that use locked screws to provide stability without compressing the bone, reducing stress shielding and risk of infection compared to conventional plates.

1. Bone plates
Dr Saiel Kumarjuvekar
JR3 Orthopaedics
BJGMC & SGH PUNE

2. Introduction
• The goal of plate fixation is to restore anatomy and impart mechanical
limb stability, ultimately allowing uneventful fracture healing.
• It transmits forces from one end of the bone to other, thus protecting
the area of fracture.
• It also holds the fracture ends together , maintaining proper
alignment during the healing process.

3. Classification/ Principles
• Protection [ neutralization] plate
• Compression plate
• Bridge plate
• Buttress plate
• Condylar plate
• Tension band plate

4. Protection [ Neutralization ] Plate
• Plate is applied as an adjunct to lag screws.
• In fractures such as short oblique, butterfly fragments, etc,
interfragmentary compression is achieved by the lag screws and the
construct is further protected from bending , torsional and shearing
forces.
• Healing takes place via primary healing.

5. Reduce the fracture and fix the
fracture with one or more lag
screws.
The appropriately contoured
plate is applied to the bone and
screws inserted in a neutral
mode.
Depending of the plate design,
bone quality, implant availably,
and surgeon's preference, fixed
angle locking head screws,
variable angle locking head
screws or non-locking screws
may be inserted.
It is not necessary to fill every
hole, if enough screws are
inserted to obtain sufficient hold
to maintain the reduction until
the fracture heals.

8. Compression plate
• Here the plate is used to achieve satisfactory interfragmentary
compression.
• Plate is attached to one end of the fracture and then it is pulled
across the fracture site, which causes tension in the plate but thereby
producing compression at the fracture leading to primary healing.
• Various methods are used to achieve compression using plates
Dynamic compression plate
prebending the plate
eccentric screw placement
tensioning devices
Lag screw through the plate

12. Bridge plating
• Bridge plating techniques are used for multifragmentary long
bone fractures where intramedullary nailing or conventional
plate fixation is not suitable.
• The plate provides relative stability by fixation of the two main
fragments, achieving correct length, alignment, and rotation.
The fracture site is left undisturbed and fracture healing by
callus formation is promoted.
• To leave the fracture site as undisturbed as possible, bridge
plates are often inserted through a minimally invasive approach.

15. Buttress/Antiglide plate
• “holds” the bone up
• A buttress is a construction that resists axial load by
applyingforce at 90° to the axis of potential deformity.
• When used in intraarticular fractures- buttress
• When used in diaphyseal fractures- antiglide
• The plates are usually precontoured according to the shape

19. Tension band plate
• Tension band principle acts by conversion of tension forces into
compression forces.
• Application of plate on tension side
• Opposite cortex should be intact
• The function of a tension band is to convert tensile force into
compressive force. After fracture reduction, the opposite cortex
must provide a bony buttress to prevent cyclic bending and
failure of fixation.

22. Condylar plates
• These are special type of implants
• It is most commonly used in periarticular fractures , wherein it
maintains the anatomical reduction as well as fixes the metaphyseal
fragments to the diaphysis.
• Eg 95 degree dcp is used in the management of distal femur fractures,
proximal femur comminuted fractures, osteotomies of proximal
femur, etc.

23. Plate designs
• DCP
• LC-DCP
• RECON PLATES
• SEMI TUBULAR PLATES
• LOCKING PLATES

24. DCP
• First introduced in 1969
• Available as 3.5,4.5 / narrow and broad
• Can achieve absolute stability by achieving interfragmentary
compression.
• Screw insertion can be inclined upto 25 degrees in longitudinal and 7
degrees in transverse plane.
• Firmly in contact with the bone, thus hindering the periosteal blood
supply.
• Therefore , high risk of refracture after implant removal.

25. LC-DCP
• Were designed in 1994.
• Plate bone footprint is reduced.
• Decrease contact between the plate and the bone , thus maintaining
the periosteal blood supply.
• Contouring is easier and better as the thickness is uniform unlike that
of DCP., preventing kinking at he screw holes.
• More inclination possible while inserting screws.

28. Drill sleeves

30. Recon plates
• Deep notches between holes
• Easy contouring in multiple planes
• Uses - acetabulum, olecranon , clavicle , distal humerus,etc

31. Locking plates [ LCP ]
• Latest type of plate design or evolving technique of plating.
• It is used as a internal fixator.
• The pitch of the screw head is identical to the pitch of the screw body to prevent
compression.
• There are fixed angle and variable angle plating systems available.
• Shearing forces are better tolerated as compared to conventional screws and
resistance to pullout is high.
• Extraperiosteal placement, thus maintaining the periosteal blood supply by
reducing the bone plate interface.
• As the screws are tightened, they "lock" to the plate, thus stabilizing the
segments without the need to compress the bone to the plate.
• advantage to the use of locking plate/screw systems is that the screws are
unlikely to loosen from the plate.

32. • Locking plates are fracture fixation devices with threaded screw holes,
which fix the screws to the plate working as fixed angle devices.
• Pullout strength of locking screws is more than that of conventional screws
• The process of stress shielding is also reduced significantly.
• Locking plates are very useful in osteoporotic bones.
• Combi hole design, for locking and non locking screws.
• Flexibilty of choice within a single implant.
• Hybrid plating: use of locking plus non locking screws in a construct
• Locking plate fixation, on the other hand, seeks to maintain a certain
elasticity to stimulate bone healing. Locking plates are generally less
rigid than conventional plates.
• Decreased risk of infection compared to conventional plates , as
lesser bone necrosis and dead space formation.

38. mipo

40. Thank you