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External Coaptation
Bone Plates
Plate-Pin Constructs
Pins and wires
External fixators
Interlocking Nails
External Coaptation
-Type I-V
-Prognostic value?
Salter-Harris I
Distal Femoral Physeal Fx
Salter-Harris I
Distal Femoral Physeal Fx
-Cross-Pinning
-no change in strength if
enter opposite cortex
Bone Plating-Screws
Length
– head (1), shaft (2), thread (3), total (4)
Partially Threaded
Thread Diameter
– inside vs. outside diameter=thread height
– 3.5 mm cortical screw (thread height 1.0 mm)
– 4.0 mm cancellous screw (thread height 1.5 mm)
Pitch (7)
Cancellous vs. Cortical
– thread height and pitch different
Self-Tapping (8)
Terminology-Plates
Plate size
– determined by screw
– 4.5 DCP is not 4.5 mm thick
Narrow vs. Broad
– 4.5 DCP is 3.8 thick and 12 mm wide or 4.8 mm
thick and 16 mm wide
Shape
– straight, semitubular, T-, L-, spoon, reconstruction
Terminology-Plates
Distance between holes and between
central holes
– DCP, VCP, Lengthening plate
Limited contact-DCP
– grooved undersurface ↓ plate-bone contact
– similar strength to DCP b/c of additional width and
thickness
– resist bending equally over length of plate; DCP
bends at screw hole
Terminology-Screw hole
Round
– 20° of angulation, VCP
– limited to use in buttress or neutralization
Oval
– reconstruction plates
Gliding-DCP
Spherical Gliding Principal
– 40° of angulation for LC-DCP, segmental fxs
LC-DCP
-allows for increased angulation
-dynamic compression in either
direction (segmental fractures)
Screw Application
-Buttress Function
-Neutralization
-Interfragmentary compression
screws and DCP
Bone Plating
-Dynamic Compression
-Simple Transverse Fracture
-Reconstruct and compress
bony column
Plate Application
Contour plate
– ↑ bone-plate contact (30% is done well)
– ↑ load sharing between screws
– bony column remains in alignment when screws
tightened
– prestress
• plate is not in neutral axis, compression on cis-cortex
• allows for more equally distributed compression
• would rather have compression on trans-cortex