In this episode, we cover one of the most common injuries encountered in orthopaedic practice: the distal radius fracture. We unpack crucial diagnostic steps, including patient history, physical examination, and imaging, to classify fractures accurately. We then explore surgical approaches and management techniques, providing a clear blueprint for handling these prevalent injuries on your rotation.

https://ota.org/sites/files/2021-06/General%20A5%20Locked%20Plating.pdf

LOCK PLATING

• Definitions
  • Locking screw: screw with “male” threads that engage with matching “female” threads on a plate.
  • Locking plate: plate with screw holes that have “female” threads
  • When coupled together = screw is locked into the plate
• Types of Locking Plates
  • Fixed angle (Monoaxial): Screw can be locked to the plate only in ONE designed direction
    • guides threading into the hole , necessary for drilling
  • Variable angle (Polyaxial): “The screw can be locked within 10 °-15°cone” this is particularly useful for periarticular fractures where you are being very specific about the trajectory of the screw across the jont line
  • Locking plates vs Non-locked plating

Locking | Non-locked
In situations with high failure of failure with non-locked plating:poor bone qualitylimited surface areabone defectsbicortical fixation not possible“Relies on fixed angle construct, and NOT on friction between plate and bone”Biological fixation“Blood supply to bone and fracture site is PRESERVED when applied with locked screws only as the periosteum under the plate is not compressed” “Can be applied off the bone”“HOWEVER, if locking plate first secured with non-locking screw, this biological principle is lost”Disadvantages“No tactile feedback of screw purchase & bone quality”“Locking Plates usually thicker vs non-locking plates: May cause symptoms” Cold welding makes removal problematic (an issue with some titanium alloys) •More expensive than non-locking plates: Should be used when beneficial | Relies on FRICTION generated by the screws, between the plate and bone


Failure mechanism: All screws will cut out and fail in unison, requires a larger force to disrupt
| Failure mechanism: Each screw would fail individual due to loosening and pull out

Mastering the principles of Orthopaedic Surgery, one break at a time.

Hosted by Dr. Kaid van Kampen
Produced by the UBC Orthopaedic Continuing Professional Development Program

In Collaboration with COSSNET and the Canadian Orthopaedic Association