A fractured bone requires careful stabilization and support to hold body’s weight and to allow movement. Microlock Locking Hand Plates are kind of internal splints which hold the fractured ends of bone together. Plate fixation of fracture means a type of stabilization with load sharing and load bearing attributes.
In treatment of fractured limb, the bone plate construct determines the joint movability, coordination and strength of muscles. The congruency of working of fixation and the fracture’s biology accounts for the fracture consolidation.
Bridge plating uses orthopedic bone plates like Locking Clavicle Hook Plate as an extra medullary splint that is fixed to the two major fragments. However, the complex fracture area is practically left untouched or preferably bridged by using bone plate.
Thus fracture consolidation and inter-fragmentary callus formation can be attained by the proper mechanical stability of the plate with compatible biology of the fracture. Techniques of bridge plating can be applied to all type of complex fragmentation in long bone fractures and where intramedullary nailing is not advisable.
The sustainability of soft-tissues and fragments is at risk in simple direct open fracture. The risk is higher in multi-fragmentary fractures as compared to simple fracture. In fact, the main concern is to keep up the vascularity at the fracture area that is a strong indicator for applying bridging technique in significant fragmentation of fracture pattern.
The endosteal blood supply of fragments is disrupted in type C fractures. Bone vitality of periosteal vascularity is accountable for the healing of fracture so its maintenance is necessary. If there is no mechanical continuity between the two major fragments, then bridging plate is to maintain the stability.
In type C fractures, extensive vulnerability with fixation by inter-fragmentary compression and periosteal clearing for accurate fragment reduction poses high risk of complication of bone healing.
The major cause of failures are: wrong application of technique, wrong explication of the principle of inter fragmentary compression, and mechanistic thinking. If an extensively fragmented fracture area is to be constructed again biologically and fixedly, it may result in implant failure or loss of stability and also can cause infection.
Anatomical reconstruction and rigid fixation of the joint surface are very important in type C fracture of the metaphyses and articular fractures. Whereas the metaphyseal bone, considering its good healing attributes, will resist severe induced damage from manipulation as compare to diaphysis. The more risky area is compact bone of the diaphysis than the metaphysis.
This transition area remains consistently under bending loads and show a definite susceptibility for delay in healing or failure in healing. If there is no chance of developing sufficient callus in bone, then fracture fixation may fail. That is why, use of bone grafting was generally suggested in former times. In case, if biology was not acknowledged, the bone grafting proved a good solution.
The plating concept which is followed in present time is based on the principle of considering biology prior to mechanics. This concept proves to be more adaptable as it varies according to the nature and severity of the fracture. So it is an individual perspective for internal fixation.
The mechanical stability of high level is needed in a simple type A diaphyseal fractures. And this high level of mechanical stability can be achieved successfully intramedullary nailing or by compression plating.
In type C fractures, many inter-mediary pieces are found other than two major fragments so the fixation device quickens the healing process like formation of callus by allowing micro movements of different fragments.
If a multi-fragmentary or complex fracture is splinted, in place of anatomical reduction, the motion between intermediate viable fragments will be minimum. Thus, if the strain of tissue is in minimum range, it can increase healing of bone by callus production.
