Locked Plating

Abstract

Achieving stable fracture fixation can be difficult when fractures include short articular segments or poor bone quality as seen in osteoporosis. Locking plate technology increased the ability to achieve and maintain fracture fixation by relying on screw plate interface rather than friction between the plate and bone generated by conventional non-locking screws. Locking systems including first-generation uniaxial locking screws, polyaxially locking screws, and locking screws that allow for axial motion affect the fracture construct’s biomechanical properties, including yield strength and stiffness, which in turn can promote or suppress bone healing. Finding the balance between fracture fixation strong enough to resist physiological loading but not overly stiff that inhibits bone healing remains challenging even for the most experienced surgeons. This chapter reviews the biomechanics of locked plating—its risks, benefits, and failures.