Locked plate

The technique of locked plating, developed in Davos, Switzerland, in

the 1990s,1 has been described
as a “revolution” in fracture care.
Locked plating refers to the fact that the screw heads are threaded
and, when tightened, lock into threads in the plate. By locking the
screws into the plate, a fixed-angle construct is created that is much
less prone to loosening or toggle than traditional nonlocked plates

Advantages of locking plates

• Much higher load to failure
• May be applied using minimally invasive techniques
• Preserves blood supply to bone
• Does not need accurate contouring
Disadvantages
• Can not be used to achieve absolute stability
• Slow to heal
– Need to weight bear
• Difficult to remove
• COST

Indications
The indications for use of locking plates include the following:
(1) metaphyseal and intra-articular fractures;
(2) highly comminuted fractures, particularly those involving
diaphyseal and metaphyseal bone;
(3) osteoporotic bone;
(4) proximal tibia and distal femur fractures
(5) periprosthetic fractures.

Contraindications
(1) fractures best served with fixation other than plates (eg, patella
fracture);
(2) fractures in which the soft-tissue injury precludes immediate
plating (eg, Gustilo grade IIIB or IIIC tibia fracture);
(3) simple fracture patterns that do not require either unlocked or
locked plates
(4) fractures that would require bending of precontoured locked
plates.
Because of the increased cost of locked plates compared with
traditional nonlocked ones, use of locking plates should be reserved
for instances in which they are clearly advantageous.