From Bench to Bedside: How Stiff is Too Stiff? Far-cortical Locking or Dynamic Locked Plating May Obviate the Question

Excerpt

Plate-and-screw fracture fixation represents, at its core, perhaps the most basic and stereotypical of orthopaedic surgery procedures—the “bone broke, me fix” or “sterile carpentry” punchline of so many medical jokes. For many simple fracture patterns, compression plating, absolute stability, and primary bone healing work well. Achieving stable, rigid fixation represents a core principle of this approach. Over the last 15 years, the development of locking screws and locked-plating has allowed us to increase construct rigidity, improve purchase and stability in osteoporotic or otherwise compromised bone, and changed our approach to many comminuted fractures. These developments have enabled, and been accompanied by, greater interest in minimally invasive plate osteosynthesis, which better respects the soft-tissues and periosteal blood supply. This minimally invasive plate osteosynthesis seeks to preserve biology and improve the capacity for fracture healing. Far-cortical locking and active locked-plating of fractures represent, perhaps, the next revolution in fracture fixation. …