The narrow LCP plates are used for fixation of extra-articular metaphyseal fractures. These plates are meant for stronger stability of the fracture as the locking screws can be placed in each locking hole of the plate. Also, the plate doesn’t need to be specifically shaped to the bone to provide stability. The screws are locked in the plates accurately, thus the physiological load from the bone on top is transferred to the plate from the fractured bone. These plating systems are available in narrow as well as broad variants.
These plates are used for fixation of fractures in long bones, such as humerus, femur and tibia. They may also be used for the fixation of periprosthetic fractures, osteopenic bones, non-unions or mal-unions of such long bones.
Plates are available in various lengths and configurations, which can be chosen as per the requirement. Even though bending of the plates may not be necessary, bending irons may be used in case bending is required. For contouring, current bending instruments have to be used to match the anatomy.
The important precaution to be taken is that while bending the plate, the bending iron needs to be placed on two consecutive holes. This will ensure that the threaded holes stay intact. Too much contouring may damage the effectiveness of locking, hence care must be taken.
With the help of standard plate holding forceps, the plate may be temporarily held in place. In addition to standard plate holding forceps, Push - Pull Reduction Device may also be used. Care must be taken that the Push – Pull Reduction Device is not inserted in a combi-hole that will be required proximately for the plate fixation.
Alternatively the Threaded Plate Holder can also be used as an aid to position the plate on the bone. The plate holder may also function as an insertion handle.
The placement of the plate and direction of the screw will depend on the design of the plate. Also, if the plate has to be placed in metaphyseal regions around the joint surfaces, or has been contoured to match the anatomy, it becomes especially more important. The final screw position has to be verified using guide wire before final insertion.
With the help of a threaded drill guide, the wire sleeve is threaded inside. The non – threaded guide wire is inserted through the wire sleeve for the required depth. The depth can be verified under image intensification or fluoroscopy. Measurement is taken using a Direct Measuring Device.
The Direct Measuring Device, guide wire, and wire sleeve are removed, with the threaded drill guide intact. A drill bit of appropriate size is used to drill the near cortex, after which the threaded drill guide is removed. Finally, the locking screw of the appropriate length is inserted.
Based on the location and degree of fracture, it has to be determined whether conventional cortex screws, cancellous cortex screws, cancellous bone screws or locking screws need to be used for insertion. Also, a combination of these screws may also be used.
Universal Drill Guide of suitable dimensions has to be used for the same.