Plate osteosynthesis represents a procedure of osteosynthesis. In this procedure, the fracture of a bone is treated with the help of plates.
What is plate osteosynthesis?
Plate osteosynthesis is when the surgical treatment of a bone fracture is done with metal plates. In this procedure, the plates are used to stabilize the fracture. Plate osteosynthesis is possible on all bone areas and is suitable for all types of fractures. In most cases, the metal plates are used for fractures that directly affect the joint or for fractures near the joint. In medicine, a distinction is made between form-fit and friction-fit plate osteosyntheses.
Function, effect, and goals
Plate osteosynthesis is the term used when the surgical treatment of a bone fracture involves metal plates. In this case, the plates serve to stabilize the fracture. Plate osteosynthesis is used to treat bone fractures. The most common indications are fractures involving the joint, open fractures, fractures in patients with polytrauma, and multiple fragment fractures that are completely unstable. Other applications of this type of osteosynthesis include lower limb fractures, fractures where there is injury to nerves or blood vessels, and complete fractures of the forearm. Which osteosynthetic treatment is ultimately used depends on the position and course of the bone fracture. Plate osteosynthesis is particularly well suited for the treatment of proximal humeral fractures, humeral shaft fracture, or proximal tibial fracture. Plate osteosynthesis can be performed using different plate shapes. These include, for example, the angle plate, which is used for fractures of the distal or proximal thigh bone (femur). Support plates are another form. These resemble an L or T and are used to treat fractures that occur in the metaphyseal or epiphyseal region. In this case, reconstruction is also carried out with lag screws. Another form is the compression plate. It is used to treat transverse and short oblique fractures. The compression plate is also suitable for screw osteosynthesis. By utilizing the screw hole pattern or with the aid of a plate tensioner, compression can be achieved in the region of the fracture gap. A humeral fixation plate is used when a proximal humerus fracture is present. Special humeral head screws are used to clamp and secure the fracture within the fixator plate. Furthermore, the surgeon uses ordinary cortical screws to anchor the shaft fragment. Plate osteosynthesis also includes the neutralization plate. It has the property of neutralizing bending forces and torsional forces. Compression can be achieved through the use of lag screws. Less Invasive Stabilization System or LISS is the name given to a plate osteosynthesis procedure used to treat supracondylar fractures, intra-articular fractures and distal femoral shaft fractures. It is composed of a plate-like implant as well as locking screws. Together, they achieve the effect of an external fixator. Before performing plate osteosynthesis, the patient is usually administered general anesthesia. At the beginning of the procedure, the surgeon first returns the bone fragments to their normal position, which is also called reduction. He then treats the fracture with one of the various forms of plate osteosynthesis, which depends on the type of bone fracture in question. If an application is made to a lower limb, partial weight-bearing must be performed first, followed by full weight-bearing, because plate osteosyntheses do not have load stability. In most cases, plate osteosynthesis takes a successful course so that the fracture heals. Removal of the inserted metallic material takes place after 12 months at the earliest. The best period for removal of the plate is considered to be 12 to 18 months. Due to the risk of fracture, removal must not be carried out earlier under any circumstances.On the other hand, it is not advisable to wait much longer than 18 months before removing the material, because by then the metal has sometimes already grown in to such an extent that there is a risk of the screws breaking off in the process.
Risks, side effects and dangers
The plate osteosynthesis procedure has both advantages and disadvantages. The pluses of the surgical method include high stability and the option of early mobilization. In addition, plate osteosynthesis can be used to counteract possible malalignments. In addition, complicated fractures can also be treated in this way. However, there are also some minus points. For example, movements are often restricted after the surgical procedure due to adhesions and scarring. In addition, it is necessary to remove the metal plates through a second operation later. Although plate osteosynthesis is one of the routine medical procedures, it has the risk of some risks and side effects. For example, the plate may become loose in the bone. Furthermore, circulatory problems and bone infections are within the realm of possibility. Rarely, tendon adhesions, curvature of muscles, nerves and cartilage, and stiffening of the joints also occur. Another possible complication is the absence or insufficient healing of the bone fracture, which physicians refer to as pseudarthrosis. In addition, bone necrosis can occur, in which individual parts of the bone die. The general risks of osteosynthesis also include injury to nerves, the occurrence of blood clots, bleeding, local wound infections, allergic reactions to certain substances, and the formation of scars. Furthermore, problems due to anesthesia are within the realm of possibility. In most cases, however, major complications are very rare. Soon after the surgical plate osteosynthesis, the patient should start moving again. Excessive sparing of the bone is considered counterproductive and often leads to complications such as stiffening of the joints. Physiotherapy exercises should be performed regularly to restore a normal weight-bearing situation.
