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ORTHOPEDIC BONE PLATE
- 1. BONE PLATE Dr SUNILVISHWAKARMA K.B.B HOSPITAL , BANDRA WEST , MUMBAI
- 2. BONE PLATE • BONE PLATE ACT AS INTERNAL SPLINT HOLDINGTOGETHER FRACTURED ENDS OF BONE. • FUNCTION: 1:TRANSMITS FORCE FROM ONE END OF A BONETOTHE OTHER END , BYPASSINGTHE FRACTURE SITE 2:HOLDSTHE FRACTURE ENDTOGETHER , MAINTAINING ALIGNMENTOF FRAGMENTS
- 3. HISTORY • IN 1958 STANDARD PLATEWITH ROUND HOLE • IN 1969 DYNAMIC COMPRESSION PLATE • IN 1994LOW CONTACT DCP • IN 2011 LOCKING COMPRESSION PLATEWITH COMBINATION HOLE HAS COME INTO USE.
- 4. NAMES OF PLATE 1. SHAPE ( SEMITUBULAR , 1/3TUBULAR) 2. WIDTH OF PLATE ( NARROW , BROAD) 3. SHAPE OF SCREW HOLES( ROUND , OVAL) 4. SURFACE CONTACT CHARECTERISTICS( LC , PC) 5. SITE OF APPLICATION (CONDYLAR PLATE ) 6. ACCORDINGTO FUNCTION
- 5. PLATE : FORM • DCP • LCP • LC-DCP • RECONSTRUCTION PLATE • SEMITUBULAR PLATE – 1/3TUBULAR PLATE • POINT CONTACT –FIX • LISS
- 6. DCP • FIRST INTRODUCED IN 1969 • DANIS • CHARECTERISTIC SCREW HOLE FOR AXIAL COMPRESSION • BROAD (4.5) FEMUR • NARROW(4.5) HUMERUS • DCP(3.5) FOREARM BONE , PELVIC BONE
- 7. ADVANTAGE OF DCP • GIVE OPTION OF INCLINED INSERTION 25 DEGREE LONGITUDINAL AND 7 0TRANSVERSE • PLACEMENT OF SCREW IN NEUTRAL POSITION WITHOUT DANGER OF DISTRACTION
- 8. PROBLOEM OF DCP • UNSTABLE FIXATION • STRICT ADHERENCETO PRINCIPLE OF COMPRESSION • COMPROMISED BLOOD SUPPLY • HIGH RATE OF REFRACTURE OF BONE AFTRE PLATE REMOVAL
- 9. LC- DCP • PLATE FOOTPRINT REDUCED • STRUCTURED UNDERSURFACE / UNDERCUT SCREW HOLES • TRAPEZOID CROSS SECTION • BETTER COUNTOURABLE , REDUCED FATIGUE AT SCREW HOLE • ALLOWS BETTER INCLINATION OF SCREW IN BOTH PLANE ( LONGITUDINAL AND TRANSVERSE) • ALLOWS SMALL BONE BRIDGE BENEATHTHE PLATE
- 10. ALLOWS MORE INCLINATION OF SCREW IN LOGITUDINAL ANDTRANSEVERSE PLANE LOW BONE CONTACT – LESSVASCULAR DAMAGE UNIFORM PLATE STRENGHT A(DCP): PLATETENDS O BEND IN AREA OF SCREW HOLE B(LC-DCP):UNIFORM STIFFNESSWITH OUT RISKOF BUCKLING AT SCREW HOLES
- 11. TUBULAR PLATE • 3.5 SYSTEM -> 1/3TUBULAR PLATE • 4.5 SYSTEM SEMITUBULAR PLATE • LESS STABILITY • USED FOR-> LATERAL MALLEOLUS DISTAL ULNA OLECRENON DISTAL HUMERUS
- 12. RECONSTRUCTION PLATE •ACURATE COUNTOURING OF PLATE •SHOWS DEEP NOTCHES •USED IN PELVIC BONE ACETABULUM CLAVICLE OLECRENON DISTAL HUMERUS
- 13. LCP •NEW DESIGN IN PLATE •COMBINES OF LOCKING SCREW AND CONVENTIONAL SCREW •PLACED IN EXTRAPERIOSTEAL PLANE •CALLED INTERNAL EXTERNAL FIXATOR
- 14. •COMBINES PRICIPLES OF DCP PLATE AND LOCKING HEAD PRINCIPLE •SPECIAL SCREW : CAN ACCEPT EITHER CORTICAL OR LOCKING SCREW •FLEXIBILITY OF CHOICE WITHIN SINGLE IMPLANT •FIXED ANGLE STABILITY •UNICORTICAL FIXATION CAN ALSO BE DONE •CONICAL SCREW HEAD
- 15. LOCKING COMPRESSION PLATE PRINCIPLE :ANGULAR STABILITY WHEREAS STABILITY OF CONVENTIONAL PLATE IS DUETO FRCTION BETWEEN PLATE AND BONE LOCKING HEAD PRINCIPLE PROVIDE RELATIVE STABILITY HEALING BY SECONDARY INTENTION WITH CALLUS FORMATION
- 16. • STABILITY UNDER LOAD DUETO LOCKING OF SCREWTO PLATE AXIAL FORCE ISTRANSMITTED OVERTHE LENGTH OF PLATE SECONDARY LOSS OFTHE INTRAOPERATIVE REDUCTION IS REDUCED • BLOOD SUPPLYTO BONE NO ADDITIONAL COMPRESSION AFTER LOCKING PERIOSTEAL BLOOD SUPPLYWILL BE PRESERVED
- 17. PRINCIPLE OF INTERNAL FIXATION BY LCP 1. 1ST REDUCETHE FRACTURE IN ANATOMICAL POSITION 2. CORTICAL SCREW SHOULD BE USED 1ST IN A FRACTURE FRAGMENT 3. IF LOCKING SCREW IS USED FIRST AVOID SPINNING OF PLATE 4. UNICORTICAL SCREW CAUSES NO LOSS OF STABILITY 5. IN OSTEOPOROTIC BONE USE BICORTICAL SCREW
- 18. 6.IN COMMINUTED FRACTURE SCREW HOLES CLOSETO FRACTURE SHOULD BE USEDTO REDUCE STRAIN . 7.INTHE FRACTURE WITH NO BONE GAP OR SMALL GAP IMMEDIATE SCREW HOLES SHOULD BE LEFT UNFILLEDTO REDUCE STRAIN.
- 19. INDICATION • OSTEOPOROTIC BONE • PERIPROSTHETIC FRACTURE • MULTIFRAGMENTRY FRACTURE • METAPHYSEAL FRACTURE
- 20. ADVANTAGE 1. ANGULAR STABILITY 2. AXIAL STABILITY 3. PLATE COUNTORING NOT REQUIRED 4. LESSVASCULAR DAMAGE 5. LESS SOFTTISSUE DAMAGE AND INFECTION
- 21. PC-FIX •NEW SYSTEMTO ABOLISH ILL EFFECT OF BONETO PLATE CONTACT •CONCEPT OF INTERNAL FIXATOR •LOCKING HEAD SCREW •SELFTAPPING , UNICORTICAL ONE LENGTH SCREW
- 22. LESS INVASIVE STABILIZATION SYSTEM •PRESHAPED PLATESWITH SELF DRILLING AND SELF TAPPING SCREWWITHTHREAD( LOCKING SCREW) •INSRTION OF SCREWTHROUGH SMALL SKIN INCISION
- 23. CLASSIFICATION BASED ON FUNTION •NEUTRILISATION PLATE •COMPRESSION PLATE •BUTTRESS PLATE •BRIDGE PLATE •TENSION BAND PLATE •CONDYLAR PLATE
- 24. NEUTRILISATION PLATE •USEDWITH LAG SCREW •PLATE IN ONLY PROTECTIVE •MEASURE INTERFREAGMENTARY BY SCREW •COUNTERACTTORSIONAL , BENDING, SHEARING FORCE •SCREW GENERATE FORCE OF 3000N
- 25. INDICATION OF NEUTRALIZATION PLATING • SHORT OBLIQUE FRACTURE • LONG SPIRAL FRACTURE • FRACTURE WITH BUTTERFLY FRAGMENT • MILD COMMINUTION OF LONG BONE FRACTURE • IN FIXATION OF LONG BONE SEGMENTAL FRACTURE IN COMBINATION WITH BONE GRAFTING
- 26. COMPRESSION PLATE • PLATE GENERATE LOCKING FORCE ACROSS FRACTURE • FOLLOW NEWTONSTHIRD LAW OF MOTION • COMPRESSION IS PRODUCED ACROSS FRACTURE SITE
- 27. ROLE OF COMPRESSION •COMPACTION OF FRACTURE -> INCREASES STABILITY •REDUCTION OF SPACE BETWEEN FREAGMENT->REDU BON GAPTO BE FILLED •PROTECTION OF BLOOD SUPPLY •ABSOLUTE STABILITY •PRIMARY OSTEONAL HEALING
- 28. TECHNIQUES • SELF COMPRESSING PLATE • TENSIONING DEVICE • ECCENTRIC SCREW PLACEMENT • COUNTOURING PLATE • PLACEMENT OF LAG SCREWTHOUGH PLATE • COMPRESSION BY OVER BENDING OF PLATE
- 29. SELF COPRESSION PLATE • EVICE CONVERTING APPLIEDTORQUE INTO COMPRESSION FORCE • SCREW HOLE HAVE UNILATERAL OR B/L INCLINATION/SLOPED. • CREATESTENSION FORCE IN PLATE AND COMPRESSION AT FRACTURE.
- 31. ECCENTRIC SCREW PLACEMENT • SHEAR STRESS IS CREATED IN SCREWWHILE PLACEMENT OF ECCENTRIC SCREW • THIS FORCE IS USED IN INTERFRAGMENTARY COMPRSSION • MECHANICALLY INEFFICIENTTECHNIQUE
- 32. COUNTOURING PLATE •TO FIT ANATOMY OF BONE •BENDING PLIERS , BENDING IRONS ARE USED •PLATE MAY GET WEAKEN BY REPEATED BENDING
- 33. LAG SCREW PLACEMENTTHROUGH PLATE •COMPRESSION +RIGIDITY OBTAINEDWITH ONE CONSTRUCT. •COMPRESSION PLATE FIRST •THEN LAG SCREW PLACEDTHROUGH PLATE
- 34. COMPRESSION BY OVERBENDING •WHEN STRAIGHT PLATE IS APPLIED ON STRAIGHT BONETRANSVERSE FRACTURE TENDSTO OPEN •DUETO ECCENTRIC FORECE ACTING ON OPPOSITE SIDE.
- 35. •TO AVOIDTHIS PREBENDING DONE. •THIS CAUSES COMPRESSION OF OPPOSITE AND NEAR CORTEX •WHOLE OF FRACTURE GETS FIRMLY COMPRESSED
- 36. PREREQUISITE OF PREBENDING 1.COUNTORTO FITTHE BONE SNUGLY 2.MAKE A SHARP BEND OPPOSITETO FRACTURE SITE ; MIDSECTCTION GETS ELEVATED 3.FIXTO BONE STATRTING FROM EITHER SIDE OF FRACTURE AND MOVING OUTWARD 4.APPLIED ONLY FORTWO FRAGMENT FRACTUTRE . 5.OPPOSITE CORTEX BUTTRESS REQUIRED.
- 37. •SIMILAR PRINCIPLE WHEN APPLIEDTO INTRA- ARTICULAR FRACTURE IT IS REFFERED AS BUTTRESS PLATING •SAME PRINCIPLE WHEN APPLIE DTO DIAPHYSEAL FRACTURE IT IS CALLED AS ANTIGLIDE PLATING
- 38. BUTTRESS PLATE APPLICATION • SCREW INSERTION BEGIN IN AREA OF MAX MOTION • FIRST SCREW SHOULD BE ECCENTRICTO PREVENT SLIDING OF PLATE • PLACEMENT BEGINS CLOSESTTO FRACTURE OR MIDDLE OF PLATE • FOLLWED ORDERLY PLACEMENT OF SCREW IN B/L DIRECTION • EXAMPLE .T-PLATE IN FRACTURE TIBIAL PLATEAU AND DISTAL RADIUS • SPECIALTYPE– ANTIGLIDE PLATE •
- 39. ANTI-GLIDING PLATE • TYPE OF BUTTRESS PLATE • 1/3TUBULAR PLATE USED • APPLIED IN LOWER 1/3 FIBULA FRACTURE (OBLIQUE) • PREVENTS DISPLACEMENT OFTIP OF FIBULA
- 40. BRIDGE PLATE • NEURILIZATION PLATE ACT AS BRIDGE • MECHANICAL LINK BETWEEN HEALTHY BONE ACROSSTHE FRACTURE • NO COMPRESSION AT FRACTURE SITE • TRANSMITTING THE DEFORMING FORCE ACROSS FRACTURE SITE
- 41. CONDYLAR PLATE • USED IN INTRA-ARTICULAR FRACTURES OF FEMUR CODYLE • REDUCTION OF INTRA –ARTICULAR FRAGMENT -> JOINT ANATOMY • FIXING MEAPHYSISTO DIAPHYSIS -> EARLY MOBILISATION • COMBINES PRINCIPLE OF COMPRSSION , NEUTRILISATION , BUTTRESS PLATING • EXAMPLE 950CONDYLAR PLATE IN INTER CONDYLAR FEMUE , FOUR PART PROXIMAL FEMUR , PROXIMAL FEMUR OSTEOTOMY
- 43. PREREQUISITE FORTENSION BAND PLATING •BONE OR FRACTURE PATTERN SHOULD BE ABLE WITHSTAND COMPRESSION •AN INTACT CORTEX ON OPPOSITE •SOLID FIXATIONTHATWITHSTANDTENSILE FORCE •PLACEMENT OF PLATE ONTENSION SIDE
- 44. DYNAMIC AND STATICTENSION BAND FIXATION • DYNAMIC • TENSION BAND PRONCIPLE ON FRACTURE PATELLA : ON FLEXION DISTRACTION FORCES GETS CONVERTED TO COMPRESSION FORCE • FRACTURE OLECRENON : FIGURE OF EIGHT WIRE LOOP ACT ASTENSION BAND ON FLEXION OF ELBOW
- 45. STATICTENSION BAND •TENSION BANDTO MEDIAL MALLEOLUS
- 46. LOCKING PLATE •SCREW LOCKED IN PLATE •FIXED ANGLE AT EACH HOLE •REDUCED INDIVIDUAL SCREW FAILUR •PLATE BONE CONTACT IS NOT CRITICAL.
- 47. •INCREASED AXIAL STABILITY •INDICATION OSTEOPENIC BONE METAPHYSEAL FRACTURE BRIDGE PLATE
- 48. LOCKING PLATETYPES •TWOTYPES •FIXED ANGLE ANDVARIABLE ANGLE
- 49. FIXED ANGLE PLATE • COMMON IN USE • SCREW ARE INSERTED AT PREDETERMINED ANGLE • ALL SCREW ARE PARALEL: SCREW CROSSING AVOIDED , JOINT PENETRATION AVOIDED • SCREW HEAD IS CONICALWITH DOUBLETHREAD • SIMILAR PITCH ON BODY AND HEADTO AVOID COMPRESSION • BETTER STRENGHT THANVARIABLE ANGLE PLATE
- 50. VARIABLE ANGLE PLATE •SCREW CAN BE PLACED ATVARIABLE ANGLE 1-15 DEGREE •BETTER FIXATION OF FRACTURE AS CHOICE OF ANGLED FIXATIO AVAILABLE •CONSTRUCT GIVES BETTER REDUCTION AT COST OF LOW STRENGHT •GOOD RESULT INWELL REDUCED COMPLEX FRACTURE •CHANCES OF JOINT PENETRATION , AND SCREW CROSSING ARE PRESENT
- 51. PRINCIPLE OF LOCKING PLATE • BASIC PRINCIPLE IS ITS ANGULAR STABILITY UNLIKE CONVENTIONAL PLATE • CONVENTIONAL PLATE RELIES ON FRCTION BETWEEN PLATE AND BONE • PRINCIPLE OF FIXATION IS LOCKING SCREW • SCREW ACT LIKE PINS OF EXTERNAL FIXATOR • SO CALLED INTERNAL FIXATOR • PROVIDE RELATIVE STABILITY • HEALING OCCURS BY SECONDARY HEALING OR BY CALLUS FORMATION
- 52. CONVENTIONAL PLATE • SCREW INTENSION • PLATE BONE FRICTION • COMPRESSIONAT FRACTURE SITE • SCREW INTERFACE LOOSENING LOCKING PLATE • SCREW IN SHEAR • PLATE BONE GAP • NO COMPRESSION • NO SCREW LOOSENING
- 53. PLATE LENGTH AND SCREW DENSITY • IN MULTI FRAGMENT FRACTURE PLATE LENGTH SHOULD BE 2-3TIMES OF FRACTUTRE LENGTH • SIMPLE FRACTURE FIXATION WITHOUT COMPRESSION PLATE LENGTH 2-3TIMES OF FRACTURE LENGTH • SIMPLETRANSERVE FRACTURE PLATE LENGTH 8-10 TIMES OF FRACTURE LENGTH
- 54. PLATE SPAN RATIO •PLATE LENGTH / FRACTURE LENGTH • IN SIMPLE FRACTURE : IN COMPRESSIONTYPE 8-10 • IN SPLINTINGTYPE – 2-3 •IN MULTIFRAGMENT FRACTURE 2-3
- 55. SCREW DENSITY RATIO •NUMBER OF SCREW / NUMBER OF PLATE HOLES •SIMPLE FRACTURE : 0.3 -0.4 •MULTIFRAGMENT FRACTURE : 0.4- 0.5
- 56. NUMBER OF SCREWTO BE INSERTED
- 57. THANKYOU