Plates and Screws

Plates and their accompanying screws are commonly used to add stability while fractures, osteotomies, or arthrodeses fuse. They come in many different shapes and sizes because they have been designed to fit different areas of the skeleton. They all share the common function of stabilizing bone in an anatomically acceptable position while it heals to itself. To perform this function, the plate must be securely attached to bone with multiple screws to each fragment. When this method is used to manage fractures, the bones are placed in direct contact, and healing occurs without the large amount of callus formation seen with casting or intramedullary nailing (Fig, 2.7.2.-1). Therefore, it is often difficult to determine when fracture union is complete, and it is not uncommon for the fracture line to be visible more than 1

year after surgery (Fig.,272-2).

FIG. 272-1. A. This clavicle fracture was rigidly fixed with a plate and screws. B. Note that the fracture is healing without significant callus formation.

FIG. 272-2. This femur fracture is rigidly healed at 1 year, but the fracture line ( arrow) is still present.

COMPLICATIONS Early complications include wound infections, either superficial and amenable to antibiotics or deep and requiring surgical debridement. Later complications include nonunion of the fracture. Plate-screw constructs are simply temporizing measures. If the bone does not heal, the plate will eventually bend or break or the screws will pull out of the bone (Fig.,,272-3). Plates and screws are sometimes removed, and the bone is then at risk for refracture (often through a screw hole) for approximately 7 months.

FIG. 272-3. A. This severely comminuted, open distal femur fracture was fixed with a plate and screws. B. Despite bone grafting, the screws broke before the fracture healed.

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