Clinical application of locked plating system in children. An orthopaedic view

Abstract

In recent years, the locked plating system has gained favour in the treatment of certain fractures in adults; however, there is not much information regarding its use in children. We think there could be some advantages and applications such as: an alternative to external fixation, the bridge plating technique, unicortical screws, removal of hardware, metadiaphyseal fractures, periarticular fractures, poor quality bone, and allograft fixation. However, there are some disadvantages to keep in mind and the final decision for using it should be based on the osteosynthesis method principle the surgeon would like to apply. In this review article we discuss the up-to-date possible clinical applications and issues of this system.

Orthopaedic Fixation Devices Used in Children: A Radiologist's Guide

“…In contrast to adults, the more porous osseous matrix of pediatric bones retards fracture propagation and the increased ability to diffuse energy decreases comminution. 2 In addition, the robust healing response and well-vascularized periosteum contribute to early callus formation and a greater potential for remodeling, often leaving behind no trace that an insult ever occurred. 10,11 Therefore, treatment strategy depends on a combination of not only anatomical location, pathology, and anticipated remaining growth, but also the child's baseline activity level and cognitive comprehension.…”

“…These screws are fully threaded and have a very narrow pitch. A disadvantage of locking screws is their inability to provide compression across osseous fragments because they are locked into the plate 2,18 (►Fig. 4).…”

“…When paired with locking screws this locking mechanism serves as an internal splint and provides stability without the need for the plate to be pressed flush against the bone, which reduces hindrance to callus formation. 2,18,26 This lack of full apposition onto the underlying bone should not be mistaken for plate liftoff (►Fig. 4).…”

“…Fractures are common in children, often occurring during play and involving otherwise normal bones. 1,2 Although some fractures are amenable to closed reduction and cast placement, other fractures require surgical correction with the goal of achieving anatomical reduction, stabilization, and regaining function. Radiography remains the initial modality of choice for postoperative serial monitoring of healing response and detection of primary complications such as fracture malalignment, delayed healing or nonunion, and complications related to fixation.…”

Longterm Postoperative Hardware Complications after Open Rib Fixation

“…2 An overall complication rate of 13 per cent has been reported with plating systems in the general orthopedic literature creating debate among orthopedic researchers as to the need for routine hardware explantation after the fracture has healed. 3,4 No such data exist for the plating systems applied for rib fracture fixation.…”