Choosing the right bone plate

A bone plate is an implant that is screwed onto a bone, a joint or several bone segments. It can be used to reduce a bone fracture or correct an orthopedic deformity.

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  • What are the main types of bone plate?

    There are three main types of bone plate: compression plates, arthrodesis plates and osteotomy plates.

    For each application, a bone plate should enable:

    • Fracture reduction to restore anatomical relationships
    • Fracture fixation to ensure absolute or relative stability
    • Early mobilization of the affected area to allow for the patient’s full rehabilitation
    • Preservation of the vascularization of soft tissue and bone

      Arthrex osteotomy plates

      Arthrex osteotomy plates

  • What criteria should you take into account when choosing a bone plate?

    There are several criteria to consider when choosing a bone plate such as the application, whether the plate is locking or not, the geometry of the holes and the materials it is made of.

    • Application: compression, arthrodesis or osteotomy
    • The part of the bone concerned
    • Side concerned (right or left)
    • Locking plate or not
    • Hole geometry
    • Plate profile
    • Shape and size of the plate
    • Slotted or smooth plate
    • Materials

      Depuy Synthes tibia compression plate

      Depuy Synthes tibia compression plate

  • Bones plates: locking or not?

    There are locking bone plates that are threaded at the screw holes, and non-locking plates. Both have their own advantages.

    Advantages of locking compression plates:

    • No bone contact is required: a locking bone plate does not need to be in contact with the underlying bone, reducing the need for extreme precision when placing the plate to achieve sufficient fracture reduction.
    • Less bone damage: the locking plate system causes less damage to the underlying cortical bone than conventional bone plates that compress the plate onto the cortical bone.
    • Low risk of loosening screws: there is a lower risk of screws loosening when using locking bone plates. The risk of inflammatory complications due to loosening material is also therefore reduced.

    The main advantage of non-locking compression plates is the greater angulation possible when screwing them in.

  • Symmetrical or non-symmetrical bone plates?

    There are two main hole geometries for bone plates: symmetrical and asymmetrical. Here are their respective characteristics:

    • Symmetrical holes: most compression plates have symmetrical holes. This allows compression in both directions.
    • Asymmetrical holes: some compression plates, however, include asymmetrical holes that allow for unidirectional compression of the bone. These plates consist of a middle section that is placed at the level of the fragments to be compressed. They often offer greater freedom in terms of positioning.
  • What materials are bone plates made of?

    Stryker A bone plate for mandibular reconstruction

    Stryker bone plate for mandibular reconstruction

    The main materials used for bone plates are metal and bioresorbable polymers.

    • Metal: bone plates can come in stainless steel or titanium.
    • Bioresorbable polymers: there are bone plates made of trimethylene carbonate (TMC), polyglycolic acid (PGA), polylactic acid (PLA) and its derivatives (LPLA, DLPLA).
  • Metal or resorbable bone plates?

    Below you will find a list of the advantages and disadvantages of metal and resorbable bone plates.

    Metallic compression plates:

    Advantages: 

    • High mechanical resistance to torsion and crushing
    • The most widespread (wide availability of plates and screws)

    Disadvantages:

    • Risk of allergies and infections
    • The mutagenic effects certain metals can have on tissue
    • Risks of interference with imaging techniques (X-ray or MRI)
    • Significant palpability of the implant
    • Sometimes it is necessary to operate again to remove the plate and screws
    • Sensitivity to temperature variations

    Resorbable compression plates:

    Advantages:

    • Modular plates (can sometimes be cut if necessary before the intervention)

    Disadvantages:

    • Decreased mechanical resistance
    • Less stability of the plate and screws
    • Long resorption process
    • Use limited to certain osteosynthesis procedures
    • Limited choice of biodegradable materials

      Inion resorbable compression plate

      Inion resorbable compression plate

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