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In the treatment of periarticular fractures, the application of bone plates is of great significance. The following are its specific application methods and key points:
The selection of internal fixation surgery: For fractures around the joint, if the fracture is unstable or displaced, internal fixation surgery is usually required. Bone plates are one of the commonly used internal fixation materials. For instance, Kirschner pins, tension screws, tension steel wires with Kirschner pins, and external fixation brackets can all be used in combination with bone plates. For some complex intra-articular fractures, such as intra-articular fractures at the base of the proximal phalangeal bone, fixation methods such as tension screws, Ksler needles, tension steel wires, and external fixation scaffolds are adopted. Bone plates can play an auxiliary fixation role and increase the stability of fixation.
Fracture reduction and fixation: During the operation, the fracture site needs to be reduced to the normal anatomical position, and then fixed with a bone plate. The bone plate can provide stable support and prevent the fracture end from shifting again. For instance, for condylar fractures of the phalanges, unicompartmental fractures can be fixed by methods such as Kirschner’s needles, screws, and tension bands, while bicompartmental fractures can be fixed by methods such as small condylar bone plates, multiple Kirschner’s needles, Kirschner’s needles + screws, and Kirschner’s needles + micro external fixation scaffolds. Through the fixation of bone plates, the fracture site can be kept stable and fracture healing can be promoted.
Adapt to different fracture types: There are various types of fractures around the joint, and bone plates can be selected and applied according to different fracture types. For non-displaced fractures, such as non-displaced phalangeal neck fractures, the short arm plaster can be fixed in the functional position, and functional exercises can be carried out after 4 to 6 weeks. For displaced fractures, reduction and internal fixation are required, and bone plates are one of the important options for internal fixation. For complex periarticular fractures, such as tibial plateau fractures involving the proximal tibia, the minimally invasive internal fixation system for the proximal tibia (LISS-PLT) is equipped with a guide and supports the MIPPO technique. The bone plate is placed outside the periosteum, and non-compression fixation is used between it and the bone to protect the blood supply of the cortical bone under the bone plate, which is conducive to callus formation and fracture healing.
Reduce interference with soft tissues: With the increasing emphasis on minimally invasive principles and the biomechanical environment of local fractures, the percutaneous placement of bone plates for internal fixation (MIPPO) has gradually been promoted and applied. The screw heads of the locking compression bone plate (LCP) have well-matched threads on the screw holes of the bone plate. When placed in place, it can provide good angular stability. There is no need to apply pressure between the bone plate and the periosteum, completely solving the drawback of traditional bone plates that compress the periosteum and affect its blood supply. Moreover, since the bone plate does not need to be in close contact with the bone, there is no need for precise pre-bending, which simplifies the surgical procedures and reduces interference with soft tissues.
Bone plates can be used in combination with other treatment methods to enhance the therapeutic effect. For example, for complex fractures around the joint, an external fixator can be used for fixation first to maintain the force line of the limb. When the condition of the soft tissue permits, internal fixation treatment can be carried out. During the internal fixation treatment, bone plates can be used for fixation.