Locking Plates: Do They Prevent Complications?

William T. DeCarbo, DPM, FACFAS, and Alexander J. Pappas, DPM, AACFAS

   In a cadaveric model, Kim and colleagues compared a locking and conventional plating system for the fixation of the distal fragment of a distal fibula fracture.31 Overall, the data indicated that a locking plate construct with two distal unicortical screws was mechanically equivalent to standard plating with three distal screws. In addition, fixation with the standard plates depended on bone mineral density whereas the locking plate fixation was independent of bone mineral density. The authors state that the clinical implication of this study was that locking plates may be advantageous in patients with the most severe osteoporosis.

   Another study by Ozkaya and coworkers analyzed the treatment of distal tibial fractures with locking and non-locking plates through a minimally invasive approach.32 In their study, 43 patients with closed fractures of the distal tibia metaphysis received either a stainless steel non-locking plate or a titanium locking plate. Minimally invasive medial plating with titanium locking plates resulted in prolonged secondary healing both in comminuted and simple fracture patterns in comparison to conventional stainless steel non-locking plates. Researchers utilized no free interfragmentary lag screws in this study.

   Ahmad and colleagues analyzed percutaneous locked plating for fractures of the distal tibia.33 They reviewed 18 patients treated with locking plates. They found that distal tibial locking plates have high fracture union rates, minimum soft tissue complications and good functional outcomes. The literature shows similar fracture union and complication rates in locking and non-locking plates.

   O’Neil and coworkers compared two types of fixation for a tibiotalocalcaneal arthrodesis.34 Researchers tested an intramedullary nail with a lag screw against a locking plate with a lag screw with six cadaveric limbs in each group. The locking plate construct showed higher final rigidity than the intramedullary nail construct.

In Conclusion

After analysis of all of these studies, it appears that the best construct is a free interfragmentary screw coupled with a locking plate. This offers the most rigid construct with compression across the fracture or fusion site. Locking plate technology also affords early weightbearing of the operative extremity. This may decrease post-surgical morbidity in patients over the long term, specifically decreasing the incidence of deep venous thrombosis. Further study is needed to determine this. Locking plates seem to be a viable option in foot and ankle trauma and reconstruction cases without increasing complications.

   Dr. DeCarbo is a fellowship trained foot and ankle surgeon in private practice at the Orthopedic Group in Pittsburgh. He is a faculty member with the Monongahela Valley Foot and Ankle Reconstructive Fellowship in Monongahela, Pa. Dr. DeCarbo is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Pappas is a Fellow with the Monongahela Valley Foot and Ankle Reconstructive Fellowship in Monongahela, Pa. He is an Associate of the American College of Foot and Ankle Surgeons.

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