Bone Plate uses to treat the bone fragments fracture. A bone, if fractured needs to be properly aligned and stabilized so that it unites and is strong enough to handle the body’s weight and movement. Earlier, Doctors relied on casts and splints from outside the body to support and stabilize the bone. The development of a surgical intervention to internally set and stabilize fractured bones using Implants is now widely practiced.
To treat a fracture, the bone fragments are first repositioned (reduced) into their normal alignment during the surgical procedure. Special implants Viz. plates, screws, nails, and wires hold them together.
Some of the advantages of such an Internal fixation procedure are:
- shorter hospital stays,
- enables patients to return to their normal function faster, and
- reduces the incidence of nonunion (improper healing) and malunion (healing in improper position) of fractured bones.
The implants are made from stainless steel and titanium, which are durable and strong. In the case of joint replacement, these implants can also be made of cobalt and chrome alloy. The Implant material is compatible with the body and rarely causes an allergic reaction.
The most often used implant for internal fixation is Screws. Although it is a simple device, there are various designs depending upon the type of fracture and place of use. Screws of different sizes are used with bones of varying sizes. Screws may be used alone to hold a fracture and is used with plates, rods, or nails. After the bone unites, screws may be either left in place or removed.
Plates hold the broken pieces of bone together and work as an internal splint. Screws are used to fix it to the bone. After healing of the bone is complete, Plates may be left in place or may be removed.
Nails or Rods
Long bones in our body are hollow at its center. Inserting a rod or nail through the hollow center of the bone to hold the bone pieces together is the adopted technique in some fractures of the long bones. Screws at each end of the rod are used to keep the fracture from shortening or rotating and hold the rod in place until the fracture has healed. Rods and screws may be removed after healing is complete or left in the bone. This technique is commonly used to treat fractures in the femur (thighbone) and tibia (shinbone) bone.
Wires are often used to pin the bones back together. They are often used to hold together pieces of bone that are too small to be fixed with screws. In many cases, they are used in conjunction with other forms of internal fixation, but they can be used alone to treat fractures of small bones, such as those found in the hand or foot. Wires are usually removed after a certain amount of time but may be left in permanently for some fractures.
External fixation is often used to hold the bones together temporarily when the skin and muscles have been injured. An external fixator acts as a stabilizing frame to hold the broken bones in the proper position. In an external fixator, metal pins or screws are placed into the bone through small incisions into the skin and muscle. The pins and screws are attached to a frame outside the skin. Because pins are inserted into the bone, external fixators differ from casts and splints which rely solely on external support.
In many cases, external fixation is used as a temporary treatment for fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery.
Other times, an external fixator can be used as the device to stabilize the bone until healing is complete.
There may be some inflammation or, less commonly, infection associated with the use of external fixators. This is typically managed with wound care and/or oral antibiotics.
Sterile conditions and advances in surgical techniques reduce but do not remove, the risk of infection when internal fixation is used. The severity of the fracture, its location, and the medical status of the patient must all be considered.
In addition, no technique is foolproof. The fracture may not heal properly or the plate or rod may break or deform. Although some media attention has focused on the possibility that cancer could develop near a long-term implant, there is little evidence documenting an actual cancer risk and much evidence against that possibility. Orthopedic surgeons are continuing their research to develop improved methods for treating fractures.
The humerus bone connects the shoulder to the elbow. The upper extremity includes this segment of the body together with the hand and the forearm. The humerus is a strong bone that has the ball of the ball-and-socket shoulder joint on the top and a hinge of the elbow joint on the bottom. There are three types of humerus fractures: proximal humerus fractures of the shoulder, mid-shaft humerus fractures, and distal humerus fractures of the elbow.
Mid-Shaft Humerus Fractures
A mid-shaft humerus fracture does not involve the shoulder or elbow joints. Statistically, about 3% of all broken bones constitute this type of fracture. The most common reason for a humeral shaft fracture is a fall or high-energy injuries (motor vehicle collisions, sports injuries). Penetrating trauma (gunshot wounds) can also cause this injury. Osteoporosis is known to be a cause of many humeral shaft fractures.
The X-rays often frighten the patients, because there is only one bone connecting the shoulder to the elbow, and patients fear as though their arm is not attached. However, they should be reassured, that there is much more than bone that holds the arm and that the vast majority of mid-shaft humerus fractures heal without surgery.
Non-surgical treatments are the most common treatment options. Thanks to gravity, which works to align the humerus, and often the best treatment for a humerus fracture is simply allowing the arm to hang by the side. Furthermore, minimizing the chance of the complication is one reason to consider non-surgical treatment.
Multiple fractures, open fractures, injuries to blood vessels or nerves, and failure of healing with nonsurgical treatment (nonunion) lead to surgical treatment, which includes.
- Fracture Bracing: A fracture brace, often referred to as a Sarmiento brace, named after the physician who popularized this treatment is the most common treatment for a humeral shaft fracture. Usually, the fracture is treated with a splint or sling allowing swelling to subside, and then a fracture brace is fitted to the patient. The brace holds the humerus in alignment and looks like a clamshell. As healing progresses, patients can begin to use their shoulder and elbow.
- Metal Plates: The most common surgical treatment of a humerus fracture is to place a large metal locking plate along the humerus and secure it with screws. In comparison to non-surgical treatments, surgical treatments have higher associated risks of nerve injury and nonunion.
- Rods: An intramedullary metallic rod is placed in the hollow center of the bone. The advantage of this option is that the surgery is less invasive, and the surgeon is working far from the important nerves that travel down the arm. The concern with a rod is that healing rates are not high, and nonunion is a common problem.
Healing Time and Complications
Though complete healing of a mid-shaft humerus fracture takes several months, exercises to improve the mobility of the shoulder and elbow joints may be initiated much sooner. The two complications usually encountered are injuries to the radial nerve and nonunion of the fracture.
The radial nerve tightly wraps around the middle of the humerus and injuries to it may occur. It may be injured at the time of the fracture or during treatment. Radial nerve injuries cause numbness on the back of the hand, and difficulty straightening (extending) the wrist and fingers. Most radial nerve injuries improve with time, but the doctor needs to follow this carefully to decide on any further treatment.
Nonunion is when the fracture does not heal. Several reasons could result in a nonunion. One of the most common reasons for nonunion is surgery. The soft tissues surrounding the fracture are further disrupted by surgery and this can compromise blood flow to the site of the fracture. While, it would be advisable to avoid surgery to prevent the risk of nonunion, but in case of a nonunion surgery is almost always needed to stimulate a healing response of the bone.
Preoperative planning has always been a significant component of the complete strategy of fracture care by surgical intervention.
Preoperative planning enables the surgeon to perform the operation in his mind prior to the actual surgical procedure. It gives him an opportunity to prepare the equipment that might be needed and allows him to plan the steps of the operation, including the location of the incisions, choice of traumaimplants, reduction technique and techniques of application.
With preoperative planning the orthopedic surgeon is better prepared for surgery, therefore ensuring a higher chance of success as well as avoiding possible complications. Another benefit is that the surgeon may provide the patient with a detailed explanation of the operation so that he may obtain informed consent and forge a good patient-surgeon relationship.
Planning in MIPO
In MIPO, preoperative planning plays an even more important role. Since the fracture sites aren’t visualized or exposed, the surgeon must plan each step of the surgical procedure to make sure that the operation proceeds smoothly, precious time isn’t wasted, and that unnecessary exposure to irradiation is prevented.
The following guidelines can be helpful in the decision-making process as well as the preparation of a preoperative plan for MIPO.
Appropriate assessment of the patient and the injury is essential for correct decision making. This includes a detailed history, relevant laboratory tests, a careful physical examination, x-rays, and other ancillary imaging studies if specified.
Patient factors that need to be considered in the decision-making process include:
- Post-trauma status including hemodynamic stability
- Future expectations
- Patient compliance
- General medical status and comorbidities
- Quality of bone
- Preinjury functional status
- Patient compliance
- Future expectations
This evaluation aids to decide whether the patient is an appropriate candidate for surgery and is fit for anesthesia.
For proper assessment of the fracture, good quality x-rays are essential. Traction films are beneficial in some instances. Other imaging studies that can be helpful include CT scans, MRI, 3-D reconstructions, and vascular studies.
The fracture factors that should be taken into consideration include:
- Duration after injury
- Closed open fracture
- Simple, wedge or complex
- Associated fractures
- Location- articular, metaphyseal or diaphyseal
- Condition of the skin and soft tissues
- Neurovascular injuries
- Associated injuries
Good indications for MIPO are complex or multifragmentary fractures of the metaphysis and diaphysis and fractures of intraarticular with extension into the diaphysis.
Relative indications are simple diaphyseal fractures and some open fractures.
Graphic preoperative plan
One of the necessities of a good preoperative plan is to make a graphic representation of the fracture fragments, manipulating the fragments on paper to attain a reduction, selecting the suitable orthopedic implants and superimposing them on the reduced fracture utilizing templates, and reviewing the plan to see whether the desired result is attained.
To prepare the preoperative plan, the following are important:
- X-rays of good quality, including views of the normal side if possible
- Tracing paper (or transparencies)
- Colored felt-tipped pens and pencils
- Additional imaging such as CT scans (especially for intra-articular fractures)
- Relevant implant templates of the correct scale
- A goniometer
The following planning techniques are usually used.
- Direct overlay
- Use of the physiological axes for articular fractures
- Overlay using the normal side
Distal Femur is the part of thighbone above Knee joint, which pans out like an inverted funnel. A fracture in this bone is termed a Distal Femur Fracture.
Such fractures commonly occur in people whose bones are weak due to old age, or in younger people who have suffered high energy injuries like a car crash. In both, the elderly and the young, the injury may extend into the knee joint and may shatter the bone into many pieces.
The largest weight-bearing joint in the body is the Knee. While distal femur bone makes up the top part of the knee, the upper part of Tibia bone supports the bottom part of the knee joint.
Articular cartilage, a smooth, slippery substance covers the ends of the femur. When we bend or straighten our knee, this cartilage protects and cushions the bone.
Normal knee anatomy
Knee Joint is supported by strong muscles. Muscle in the front of our thigh is called Quadriceps, while the one at the back of thigh is Hamstrings. Apart from supporting, they also allow us to bend and straighten our knee.
There are different types of Distal Femur Fractures. The bone may break in transverse plane or into many pieces (comminuted fracture). Sometimes the fracture may extend into the knee joint and separate the surface of the bone into a few (or many) parts. Such fractures are called intra-articular. Due to damage to the cartilage surface of the bone, intra-articular fractures can be more difficult to treat.
Various fracture types of distal femur:
(Left) A transverse fracture across the distal femur.
(Center) An intra-articular fracture that extends into the knee joint.
(Right) A comminuted fracture that extends into the knee joint and upwards into the femoral shaft.
Distal femur fractures can be closed — if the skin is intact — or can be open. An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone.
Open fractures often have associated damage to the surrounding muscles, tendons, and ligaments. Thus, they have a higher risk of complications and take a longer time to heal.
The hamstrings and quadriceps muscles, both tend to contract and shorten when the distal femur breaks. In such case, the bone fragments change position and it is difficult to line up with a cast.
Distal femur fracture in which the bones are out of alignment
In this x-ray of the knee taken from the side, the muscles at the front and back of the thigh have shortened and pulled the broken pieces of bone out of alignment.
As discussed earlier, Fractures of distal femur occur mostly in younger people (under age 50) or the elderly.
Younger patients suffer high energy injuries usually caused by falls from significant heights or motor vehicle collisions. Due to the high energy impact, many patients also often have injuries of the head, chest, abdomen, pelvis, spine, and other limbs.
In Elderly people, with age the bone quality becomes poor. Bone become thinner and become very weak and fragile. A lower-force impact, like a fall from standing, can also cause a distal femur fracture. Although elderly patients do not often have other injuries, they may have concerning medical problems, such as conditions of the heart, lungs, and kidneys, and diabetes.
The most common symptoms of distal femur fracture include:
Pain with weight-bearing
Swelling and bruising
Tenderness to touch
Deformity — the knee may look “out of place” and the leg may appear shorter and crooked
While in majority of cases, these symptoms occur around the knee, but there may also be symptoms in the thigh area.
The following are some general guidelines when using these implants for Locking compression plate-LCP
- Whenever possible, the fracture is first reduced by indirect means.
- If required, the reduction is then maintained using external fixators or distractors.
- If a well-contoured or anatomically preshaped plate is utilized, the implant may be used as a reduction aid when utilized with standard screws.
- If the compression purpose of the LCP is to be utilized, for example in simple transverse fractures, correct contouring of the plate is first performed; axial compression may then be carried out utilizing standard screws in the dynamic compression unit of the combination holes. It’s significant to note that the LCP combination holes are arranged asymmetrically on the plate. This asymmetry enables axial dynamic compression to be exerted unidirectionally. After exerting axial compression by the standard screws, further LHS may then be inserted.
- If it’s desired to apply interfragmentary compression in a spiral or simple oblique fractures, this should first be accomplished utilizing standard screws as lag screws prior to the application of LHS.
- To insert standard screws, the universal drill guide is utilized. The screw holes are predrilled, either eccentrically or neutrally, depending on the screw’s intended function. The depth of the screw hole is then measured as well as the tap, and the suitable standard screw inserted.
- If plate contouring is required, it should be performed using suitable bending instruments. Bending should be done between the combination holes and not done through the holes as this can cause deformation of the holes and lead to difficulty in the following insertion of LHS. One way of preventing this deformation is to insert an LHS or a threaded drill sleeve into the threaded portion of the combination hole before carrying out the bending.
- If wanted, an LCP spacer is screwed into the plate before its insertion. The spacer ensures a gap of 2 mm between the plate and underlying cortex, therefore minimizing plate-bone contact and preserving periosteal circulation. This spacer may be removed after insertion of the LHS.
- Skin incisions are made, corresponding in location to the ends of the plate.
- A tunneler can be used to create a submuscular extra-periosteal tunnel for the locking bone plate.
- The bone plate is then passed into the tunnel. This may be done in one of many ways. If a tunneler is utilized, one end of the plate is tied with a suture to the end of the tunneler. As the tunneler is withdrawn, the bone plate is pulled into position. Another way is to fix the plate’s one end with a plate holder or a threaded LCP drill guide which is then utilized to guide the plate into position along the track made by the tunneler.
- Once the plate is in place, bone screw insertion may follow. If the first inserted bone screw is an LHS, before locking, the other end of the plate should be temporarily stabilized with either a standard screw, a K-wire, a threaded LCP drill guide, or another LHS that isn’t locked. This is to avoid the plate from rotating and causing damage to the surrounding soft tissue as the 1st LHS is tightened and locked.
- If the equal of fracture reduction is satisfactory, the rest of the LHS is inserted.
- To insert a self-tapping LHS percutaneously, a threaded LCP drill guide is 1st introduced through a stab incision in the skin and then screwed into the threaded part of the selected combination hole. The drill guide makes sure that drilling is done in an accurate direction so that the screw is appropriately locked to attain maximal angular stability. The screw hole is then drilled and measured, and the suitable LHS inserted, first utilizing a power tool with the screwdriver shaft and then performing the final tightening by hand with the torque-limiting until clicking happens.
- Predrilling and depth measurement aren’t essential if a self-drilling, self-tapping LHS is used monocortically. This, though, is only possible in good-quality bone with a thick cortex. Monocortical screw fixation is also specified in periprosthetic fractures.
There are two bones in the broken forearm – the radius and the ulna. When one or both the bones of the forearm have a fracture, we term it as Forearm Fracture. Both bones are important not only for proper motion of the elbow and wrist joints but also serve as important attachments to muscles of the upper extremity.
A most common reason for fractures is due to a fall on the hand, or a direct blow to the forearm (commonly seen in altercations, sports injuries, and car accidents). Pain, swelling, and deformity of the forearm indicate a forearm fracture. Proper diagnosis can be made with physical examination and x-ray studies.
Radial shaft fractures, ulnar shaft fractures, and fractures of both forearm bones are discussed below. Siora Surgicals has manufactured a locking plate for hand fractures. Other Fractures that occur around the elbow (radial head fractures and olecranon fractures) and those that occur around the wrist (wrist fractures), will be covered separately.
Radial Shaft Fractures
It is not common to suffer an isolated fracture of the radial shaft. Most fractures of the radial shaft are associated with injury to the ulna (see ‘both bones forearm fracture’ below) or injury to one of the joints around the wrist (Galeazzi fracture).
An isolated radial shaft fracture, if it occurs, commonly requires surgery unless the fracture is non-displaced. If the fracture is out of position, then the fracture is realigned to allow forearm rotation. Hence, surgery is the preferred treatment option to realign and hold the bones in the proper position.
Ulnar Shaft Fractures
An isolated fracture to the ulna is most often caused during an altercation and is called a “nightstick” fracture. Raising of the forearm in a protective posture exposes the ulna bone, which can be damaged by a blunt traumatic hit. The name is derived from the defensive gesture of people trying to shield themselves from a policeman’s nightstick leading to ulnar fractures.
If the fracture is well aligned, an isolated ulna fracture can be treated with immobilization in a cast. However, if the fracture is badly displaced, or the skin is broken causing an open fracture, then surgical treatment is advised.
Both Broken Forearm Fracture
Fracture of Both bones almost always require surgery in an adult patient. Without surgery, the forearm is generally unstable and to cast this type of fracture in a proper orientation is very difficult if possible. In younger children, nonsurgical treatment can be considered, but in adolescents, surgery may have to be carried out.
Fractures of both bones of the forearm are most commonly treated by fixing a metal plate and screws on both the radius and ulna bones. These bones have to be approached through a separate incision, necessitating, therefore, you will have two incisions on your forearm. Some surgeons may use a rod within the bone to maintain the position of the bone, but this cannot be done in fractures where rotational stability is required. Hence, both bones forearm fractures are mostly treated with plate and screws.
Complications of Broken Forearm Fractures
The complications that are commonly encountered in such fractures include:
- Limited Motion: After the treatment of forearm fractures, decreased motion capability is common. It can be limited in the elbow and wrist joints but is most commonly noticed in forearm rotation (i.e. opening a jar or turning a door handle).
- Non-Healing Fracture: Due to inadequate healing of the bones of the forearm, there may be persistent pain. In open Fractures or where the bone is lost (i.e. many small pieces), this problem is more likely to occur. In such cases, repeat surgery for bone grafting may be necessary.
- Infection: Post-surgery, the possibility of Infection is common. An infection in forearm fracture after surgery may require the removal of the metal implants and screws to cure the infection.
- Painful Hardware: Many times, the metal implants used during surgery can be felt under the skin and are painful. They can be removed, after the bone has properly united, usually at least a year after surgery.
The overview of the internal fixator has made MIPO a more practical theory and expanded its scope and range of applications.
The internal fixator is a submuscular or subcutaneously positioned external fixator. The design feature that is unique to the internal fixator is the locking head screw (LHS)- the screw head incorporates a double conical thread for safe fixation into a corresponding conical thread in the hole of the plate. This characteristic imparts a degree of angular stability to the construct because the locked screw head can no longer toggle within the plate hole. Also, because the screw head is secured within the plate hole, it doesn’t press the plate against the underlying bone as the screw is tightened, in contrast to standard screws such as cancellous or cortex bone screws.
The internal fixator, therefore, possesses characteristics that make it suitable for MIPO. These include:
- LHS prevents the boneplate from being pressed against the underlying bone, therefore sparing the periosteal blood supply.
- Since the bone isn’t pulled against the plate by the LHS because the bone screws are tightened, there is no loss of primary reduction if the fracture has previously been reduced.
- Consequently, correct contouring of the plate isn’t necessary, a definite benefit in MIPO as the bone isn’t exposed for templating.
- Angular stability of the construct also avoids secondary loss of fracture’s reduction when placed under load.
- As the LHS are either self-tapping and self-drilling or only self-tapping, application of screw is made easier in the MIPO setting as drilling and/or tapping is no longer needed as is the situation with the application of standard screws.
The 1st internal fixator specifically intended for use in MIPO was the less invasive stabilization system (LISS) for the distal femur. As the benefits of the LISS became apparent, demand for a more versatile system risen, and this result in the development of the locking compression plate (LCP) with a specially intended combination hole, one half of which is intended as a dynamic compression until that enables the use of standard screws for interfragmentary or axial compression, while the other half is threaded to enable the application of LHS. Therefore, the LCP may function as a compression plate or as an internal fixator when only LHS are utilized.
In theory, no contouring of the LCP is essential when used as an internal fixator, however in practice, some degree of contouring is usually required, especially in the bone’s epi-metaphyseal segments. Otherwise, the plate can stand proud and become prominent subcutaneously or cause irritation of the adjacent soft tissue. To overcome this issue, specially intended metaphyseal plates were introduced. The special characteristics of this plate are that the juxta-articular end of the plate is thinned out to aid contouring and the two distal holes in this thinned part of the plate are angled at 11⁰ toward the center of the plate to enable the optimal application of the LHS in the epiphyseal part in order to avoid penetration of the articular surface. A further refinement of this is the progress of anatomically preshaped LCP for use in specific epi-metaphyseal portions of the skeleton.
The metaphyseal end of such a plate enables the insertion of a cluster of LHS in a convergent or divergent manner to improve their pull-strength. Additionally, no contouring of the plate is usually required. An added benefit of this anatomical preshaped LCP is that they may be used as an aid for indirect fracture reduction when utilized with standard screws. These may draw the bone toward the plate and therefore affect an adaptation of the bony fragments to the shape of the bone plate. Examples of anatomically preshaped LCP are the LCP distal humerus, locking proximal humerus plate (LPHP), LCP distal radius, LCP distal femur, LCP distal tibia, and LCP proximal lateral tibia.
Hands cannot perform its routine tasks without the use of the wrists. Hence, older individuals, who experience arthritis undergo various rehabilitative, non-invasive treatments to restore all or most wrist functions as soon as possible.
Unfortunately, cases of severe arthritis may cause patients to suffer from extreme pain and lose all functions of the wrist. It may also render the wrist unresponsive to non-surgical forms. This is where total wrist replacement comes in, also called wrist arthroplasty. Orthopedic instrument manufacturers provide orthopedic implants and medical devices to carry out the procedure of wrist arthroplasty.
Wrist Arthroplasty Surgery
The wrist is a complex network of bones, cartilage, and ligaments that each play a role in the smooth movement of the wrist. When the cartilage is worn away because of disease, injury, or infection, the bones of the wrist begin to rub against each other, causing unnatural wear on the ends. This is known as arthritis, which interferes with your ability to grasp objects.
Wrist arthroplasty involves removal of the damaged ends of the bones and replacing them with a synthetic joint, also called prosthesis. The prosthesis is made from medical-grade metal and high-quality plastic polythene and is intended to closely resemble the anatomy of the wrist.
The surgery can be performed under local anesthesia or general anesthesia, depending on one’s needs or preferences. An important point to note here is that modern wrist arthroplasty is performed on an outpatient basis.
Wrist Arthroplasty Rehabilitation
The first few weeks after surgery are spent wearing a cast that keeps the wrist in a neutral position to avoid swelling. Once the cast is removed, for the next 6 to 8 weeks, the patient must wear a protective splint. Total wrist arthroplasty rehabilitation spans anywhere from 3 to 6 months, restoring approximately 50% of healthy movement. The prosthesis lasts up to 15 years, depending on the physical demands of your everyday activities.
To prolong the life of prosthesis as well as resolve any complications at the point of time they occur, following up with orthopedic surgeon throughout recovery and every following year is the key to success. One also needs to work with a qualified physical therapist on pain management, and, eventually, exercises that restore endurance, strength, and range of motion.
Bone plates work like internal splints which hold together the fractured parts of a bone. These plates are available in all size, thicknesses, and shapes to suit the bone for which it is to be used. Over the years, developments in material science and engineering have led to the evolution of different shapes and size of the plates for clinical use.
In the initial phase of development of plates, surgeons such as Lane and Lambote used them to merely fix two bone fragments in approximate alignment. There were frequent Mechanical failures due to the metal reaction, inadequate design of screws and plates, etc.
The first use of interfragmentary compression by applying for plates under tension along the longitudinal axis of the bone was carried out by Danis, a Belgian surgeon in 1949. The concept was further explored and perfected thereafter by Muller and the AO group.
A bone plate has two mechanical functions. It transmits forces from one end of the bone to the other, bypassing the area of fractures and thus protecting them. Throughout the healing process, it also holds the fracture ends together while maintaining proper alignment of the fragment.
The names given to bone plates can refer to the shape of the plates (semi-tubular or one-third tubular plate), or some time to the width of the plate (broad or narrow plate). A name may be derived from the shape of the screw holes (round hole plate), or from the surface contact characteristics of the plate (low contact), or from the intended site of application (condylar plate).
Regardless of their geometry, configuration, length, thickness, or types of holes, all plates may be classified into four groups according to their function.
Neutralization Plate –
A neutralization plate transmits various forces from one end of the bone to the other, bypassing the area of the fracture and acts as a ‘bridge’. Its main function is to maintain a mechanical link between the healthy segments of bone above and below the fracture. Such a plate does not produce compression at the fracture site.
A plate used in combination with a lag screw is also a neutralization plate, counteracting the torsional, bending and shearing forces that tend to disrupt the screw. The lag screw contributes to the interfragmentary compression and stability. The neutralization plate merely protects the lag screw, allowing mobilization of the extremity.
In exceptional circumstances, a neutralization plate can produce compression at the fracture site, if the geometry of the fracture permits it.
The most common clinical application of the neutralization plate is to protect the screw fixation of a short oblique fracture of a long bone, or for the fixation of a segmental bone defect in combination with bone grafting.
A clavicle fracture is a type of treatment to fix a broken bone. Open reduction and internal fixation (ORIF) are one of the treatment options to fix a broken bone. It puts the parts of a broken bone together so that they can heal. Open reduction means the bones are put back in their place during surgery. Internal fixation means that special hardware is used to hold the bone parts together. This helps to correct the bone accurately. The procedure is done by an orthopedic surgeon using orthopedic implants & instruments provided by the orthopedic instrument manufacturers in India.
How do I prepare for a clavicle fracture open reduction and internal fixation?
Before ORIF physical and X-ray examination of the site of injury is necessary. A doctor would like to get even details like the medicines you take, including over-the-counter medicines such as Aspirin. Also, tell your doctor the last time you ate.
Doctors might perform your ORIF as a planned process. If this is the case, ask whether you should stop taking any medicines ahead of time, for example, blood thinners. You will need to avoid drink and food after midnight the night before the procedure.
What happens at the time of a clavicle fracture open reduction and internal fixation?
An orthopedic surgeon and a team of specialized healthcare professionals will perform the procedure with the help of orthopedic surgery instruments obtained from orthopedic instrument distributors in Jakarta. The whole operation may take two hours. In general, you can expect the following:
- You will receive general anesthesia to make you sleep through the operation so that you would not feel any discomfort or pain.
- A healthcare professional will carefully monitor your vital signs, such as your blood pressure and heart rate during the operation. You may have a breathing tube placed down your throat during the operation to help you in breathing.
- After cleaning the affected area, your surgeon will make an incision through the muscle and skin near your clavicle.
- Your orthopedic surgeon will bring the pieces of your clavicle back into alignment (reduction).
- Next, your surgeon will secure the clavicle pieces to each other (fixation). To do this, she or he may use one or more of the Orthopedic Implants viz. bone screws, orthopedic plates, wires, and pins.
- Your doctor may make other essential repairs.
- Locking Reconstruction Plate 3.5 MM Straight is used for the clavicle fracture
- After the team has secured the bone, your surgeon will surgically close the layers of muscle and skin around your clavicle.
What happens after a clavicle fracture open reduction and internal fixation?
You may have some pain after your procedure, but pain medicine may help to lessen the pain. You should be able to resume a normal diet as soon as possible. You will probably require an imaging procedure, like an X-ray, to ensure that your surgery was successful. Depending on the extent of your injury and your other medical conditions, you may be able to go home that same day.
For a while after your surgery, you will need to keep your arm immobile. Usually, this means that you will need to wear your arm in a sling for several weeks. You will get instructions about how you can move your arm.
Your doctor might give you other instructions about caring for your clavicle, such as applying ice. Your doctor might not want you to take certain over-the-counter medicine for pain, because some of these can interfere with the healing of bone. your doctor may advise you to eat a diet high in vitamin D and calcium as your bone heals.
You might have some fluid draining from your incision. This is normal. Let your doctor know right away if:
- You see an increase in swelling, redness, or draining from your incision.
- You have high chills or fever
- You have severe pain
- You have a loss of feeling somewhere in your body
Make sure to have all your follow-up appointments. You may need to have your staples or stitches removed in a week or so.
At some point, you may need physical therapy to restore flexibility and strength to your muscles. Doing your exercises as prescribed can improve your chances of a complete recovery. Most people can return to all their regular activities within a few months.