Professional Documents
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Blade Plates
Tubular Plates
Buttress Plates
Stability
$$$$$
ORIF
MIPPO
Biologic
RIMN
Cost
UIMN
EF
cast
$
Stability
relative absolute
Biologic Fixation
Principle
Fracture fixation giving priority to
Biology
biology over mechanics Stability
Fracture fixation with appropriate level
of stability to optimize healing
“Balanced fixation”
Longer plates, screw dispersion
Performed with minimal devitalization
Biologic Fixation
Fractures Multi fragment
Soft tissues Damaged
Location Meta/diaphyseal
Exposure Limited
Reduction Indirect - alignment
Fixation Relative stability
Healing Callus
Biologic Fixation
Indications
Complex multifrag fractures
Compromised soft tissues
Multiple injuries
Compromised host
Biologic Fixation Techniques
Exposure
Limited
Carefully planned
Meticulously executed
Respectful retraction
No violation of the injury zone
Minimize further damage
Biologic Fixation Techniques
Reduction
Indirect
Preserve vascularity
Realignment
Restore
Length
Axis
Rotation
Biologic Fixation Techniques
Fixation
Bridge plating
Long plates
Balanced
fixation
Minimize
contact
Biologic Fixation Principles
distance from
fracture site to
nearest screw
strength
Couple to Bone
Screws: where, how many and
direction
Dependent on plate length
No more than 3
Well spaced: close to fracture site, at
end of plate and one in between
Last screw in either end placed
obliquely away from fracture
Balanced in each fragment
Data: Plate Length
Tornquist JOT 1996
Relative length of
plate > effect than
more screws
elastic
deformation with
long plate, resists
bending better
Torsional
resistance
dependent on
screws
Plate Length
Most important variable
The longer the better
Dependent on length of
fracture site
Provide Ample Screw Spread
Applying long plate on tension side
Spreads axial load to furthest screws.
Spreads force over larger area
Decreases the load per unit length of
the plate
Failure of Fixation
Stress concentration – Too stable?
Complex End Segment Intra-
articular Fracture
PL
PL/FL =/> 6
Plate Screw FL
Density
Plate screws/plate holes X
100
= 50%
Rozbruch CORR 354 195-208, 1998
Biological Fixation
Plate length
8-10 times the A
one
MIPPO
CPO
Girdlestone, 1930