Contouring Plates in Fracture Surgery

Indications and Pitfalls

Julius A. Bishop, MD; Sean T. Campbell, MD; Matthew L. Graves, MD; Michael J. Gardner, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(14):585-595. 

In This Article

Abstract and Introduction

Abstract

Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending. Other reasons to contour a plate include matching patient anatomy either to maximize fixation options or to reduce implant prominence. Precontoured plates can be convenient and help to facilitate soft-tissue friendly techniques but have the potential to introduce malreduction if the plate position and fit are not carefully monitored.

Introduction

The contour of a plate used for fracture fixation can have an important effect on surgical outcomes. It is therefore critical for surgeons to both understand the rationale behind implant contouring and be well versed in the technical execution.

The modern orthopaedic plate dates back to 1965 and the introduction of the dynamic compression plate by the Arbeitsgemeinschaft fur Osteosynthesefragen group.[1] These early plates were found to cause injury to the periosteum beneath the plate and interfered with perfusion. This led to the concept and introduction of the "limited-contact" plate, which had material relief between the holes on the undersurface of the plate.[1–4] These were introduced in 1990 and are still widely used to this day.[1] Locking technology was introduced in 2000, along with some of the first precontoured implants.[1] Today, precontoured implants are manufactured to fit nearly every bone in the body but are not always useful or appropriate.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....