Surgical Methods Techniques of Osteosynthesis Plating Osteosynthesis

Plating osteosynthesis can be defined as a kind of "static fixation" because its rigidity is constant from the beginning to the end of treatment. Classical plating techniques provide environmental stability but cannot provide osteogenic stimulation, mainly in cases of atrophic nonunions: in these cases bone grafting should be associated with the treatment [29-31].

These techniques have some advantages in the management of nonunions [30]: accurate correction of a malalignment combined with nonunion; easy application of bone grafts or bone substitutes at the nonunion site, if required; good management of periarticular and intrarticular nonunions. However, they also have some important drawbacks: weight-bearing must be delayed; dissection of soft tissues and periosteal destruction may increase the risk of infection and persistence of nonunion; creation of osteoporotic zones may facilitate delayed unions and refractures (Figs. 2,3).

The disadvantages have been partially resolved by the development of new kinds of plates in recent years: limited contact-dynamic compression plates (LC-DCP) [32] and more recently locking compression plates (LCP) [33] and

Fig. 2. Nonunion of the right humerus in a 56-year-old woman treated with plating

Fig.3a, b. Same case as in Fig. 2. a Infection with failure of the internal fixation 4 months after os-teosynthesis. b Worsening of the infection and hardware mobilization 6 months after osteosynthesis less invasive stabilization systems (LISS) [34]. LCP plates have both the advantages of standard plates and screws and locked internal fixators (LIF) thanks to a combined hole which allows fixation with standard screws, auto locking screws, and a mixed fixation with both types of screws. LISS plates are an internal fixation device: they can be used at the distal femur and at the proximal lateral tibia. The premolded plate can be applied under the muscles using an adapted instrumentation, and it is left in proximity of the bone but not in contact with it. Screws can be applied percutaneously and can be locked to the plate through the threaded connection screw-internal fixator.

Series reported by Helfet et al. [35], Wiss et al. [36], and Zinghi et al. [31] show satisfactory results obtained by means of the "static fixation" by plating in noninfected nonunions.

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