Cath Lab Digest

Using plates and screws for bone fixation is a standard and successful technique. However, any fixation with plates and screws involves some amount of additional trauma and insult to the osseous blood supply of fracture fragments. These disturbances increase the risk of delayed union and infection.¹
Indeed, reconstructive and trauma procedures of the foot and ankle present unique challenges for foot and ankle surgeons. As these cases grow in complexity, certain principles prevail in ensuring predictable and successful outcomes. These principles emphasize the protection of the soft tissue envelope and the importance of bone callus formation in uniting fractures and osteotomies. The technology of locking plates provides surgeons with an option that addresses both soft tissue preservation and bone callus formation.
As the technology progresses, we have also seen a growing number of indications and implications for locking plates in foot and ankle reconstruction and trauma procedures.
The ability to obtain a fixed angle and a rigid interface between the screw and plate is the basis behind locking plate technology (i.e. an internal–external fixator). This concept allows surgical approaches that protect the soft tissues while fostering an environment that is prime for secondary bone healing and preservation of the local osseous vascular supply.² Given the traditional plating options that involve compressing the plate to the bone at the expense of extensive soft tissue exposure, the interest in alternative locking plate technology continues to grow. In an attempt to decrease the risks associated with wound and fracture healing, surgeons are finding locking plate technology more favorable.
In order to achieve functional rehabilitation of the lower extremity following fracture, anatomic reduction, rigid internal fixation and early joint motion always remain the starting points for fracture and bone healing.³ However, as delayed healing and other complications arose, there was an increased emphasis on limiting the extent of soft tissue dissection and bony devascularization. External fixators, distractors and other methods were introduced to preserve osseous perfusion and soft tissue integrity. Plates underwent redesigns to limit bone contact to further preserve bony vascularity.
Now locking plate technology offers a biologically friendly plating system that creates fixed angle plate screw constructs. Foot and ankle surgeons can use these constructs when considering surgical correction of complex deformities of the lower extremity.