INTRODUCTION

BONE HEALING

Events in fracture healing are responsible for debridement,

stabilization, and ultimately remodeling of the fracture site.

Healing can take place either primarily, in the presence of rigid

fixation, or secondarily in the absence of a rigid fixation.

PRIMARY BONE HEALING

• Occurs with direct and intimate contact between the fracture

fragements.

• The new bone grows directly across the compressed bone

ends to unite the fracture.

• Primary cortical bone healing is very slow and cannot bridge

fracture gaps.

• There is no radiographic evidence of a bridging callus with

this mode of healing.

• It usually occurs approximately 2 weeks from the time of

surgery.

• This is the only method of healing with rigid compression

fixation of the fracture.

• Rigid fixation requires direct cortical contact and an intact

intramedullary vasculature.

SECONDARY HEALING

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 • It denotes mineralization and bony replacement of a
cartilage matrix with a characteristic radiographic
appearance of callus formation.

• The greater the motion at the fracture site, the greater will
be the quality of the callus.

• This external bridging callus adds stability to the fracture

site by increasing the bone width.

• This occurs with casting and external fixation as well as

intramedullary nailing of the fracture.

Fracture healing

There are three main phases of fracture healing

A. INFLAMMATORY PHASE

• In the inflammatory stage, a hematoma develops within

the fracture site during the first few hours and days.

• Inflammatory cells (macrophages, monocytes,

lymphocytes, and polymorphonuclear cells) and
fibroblasts infiltrate the bone under prostaglandin
mediation.

• This results in the formation of granulation tissue,

ingrowth of vascular tissue, and migration of
mesenchymal cells.

• The primary nutrient and oxygen supply of this early

process is provided by the exposed cancellous bone
and muscle.

B. REPARATIVE PHASE
2
 • This phase lasts several months.

• The fracture hematoma is then invaded by

chondroblasts and fibroblasts, which lay down the
matrix for the callus.
• Initially a soft callus is formed, composed mainly of
fibrous tissue and cartilage with small amounts of bone.
• Osteoblasts are then responsible for mineralization of
this soft callus, converting in to a hard callus of woven
bone and increasing the stability of the fracture

• This type of bone is immature and weak in torque and

therefore cannot be stressed.

C. REMODELLING STAGE

• It takes months to years.

• It consists of osteoclastic and osteoblastic activities that

results in replacement of immature disorganized bone
with a mature organized bone.

• The medullary canal gradually reforms.

3
 • There is resorption of bone from the convex surface
and new bone formation on the concave surface.

BIOMECHANICAL PRINCIPLES OF FIXATION DEVICES

Many types of devices are used for fracture fixation.

The biomachanics of fixation are based on either stress sharing or

stress shielding devices.

STRESS-SHARING DEVICE

• It permits partial transmission of load across the fracture

site.

• This results in micromotion at the fracture site, thus inducing

secondary healing with callus formation.

• Eg:- casts, rods and intramedullary nails.

STRESS- SHEILDING DEVICES

• It shields the fracture site from stress by transferring stress

to the device.

• The fracture ends of the bone are held under compression

and there is no motion at the fracture site.

4
• Hence resulting in primary bone healing without callus
formation.

• Eg:-compression platting.

Biomechanics Type of bone Rate of bone

healing healing
Casts Stress sharing Secondary Fast
Plates Stress Primary Slow
shielding
Pin, screws or Stress sharing Secondary Fast
wire
External Stress sharing Secondary Fast
fixator

5
PLASTER CASTS

INTRODUCTION

The closed treatment of fractures generally consisits of some

form of manipulation or reduction followed by application of
device to maintain the reduction until healing has occurred.

REDUCTION

The sooner the reduction of a fracture is attempted the better,

because swelling of the extremity tends to increase for 6-12 hrs
after the injury. This haemorrhage and oedema in the soft tissues
make them inelastic and pose a barrier to adequate reduction.

Contraindications of closed reduction

• There is no significant displacement

• This displacement is little concern(eg. Humeral shaft)

• No reduction is possible(eg. Communited fracture of head

and neck of humerus)

6
 • The fracture has been produced by traction
force(eg.displaced fracture of patella)

To achieve reduction following steps are adviced:-

• Traction in the long axis of the bone

• Reverse the mechanism that produced by the fracture

• Align the fragment that can be controlled with the one

that cannot

PLASTER CASTS

It is one of the methods of immobilization. It is done once the

satisfactory reduction has been achieved and must be
manipulated until primary union has taken place.

The efficiency of plaster immobilization

The object of applying POP casts is to keep the bone ends in

apposition and fracture aligned until it heals. It has been said that
immobilization by the plaster will work only where the soft tissue
is intact, where there is inherent stability of the reduced fracture
and where the cast is properly applied.

When a bone is fractured and not widely separated, the soft

tissue hinge in the concavity of the angulation is the linkage that
allows us to reduce the fracture with manipulation.

3-POINT FIXATION

This should be obtained in fracture modulating cast. For this, one

hand must exert pressure over the fracture site on the side

7
opposite to soft tissue bridge, while the other hand gently
massages the distal fragment in the proper direction to close gap.
Third force is supplied by the portion of the cast over the proximal
portion of the limb.

Charnel adviced- it takes a curved cast to produce a straight

bone, he divided fractures in to three categories:

• Those with inherent stability against shortening(transverse

fractures)

• Those with potential stability against shortening(oblique

fractures less than 45 degrees to long axis of bone.

• Those with no stability against shortening( oblique, spiral &

comminuted fractures)

However, there is another factor- the hydrodynamic effect of

cast. Because the soft tissues are semifluid, the hydrostatic
pressure increases when they are compressed by a cast. This
increase in tension tends to keep the limb from shortening as
it is most certainly would do where it is unsupported. This
factor makes possible early ambulation in fracture of tibia.

Types of cast with there specific uses:

1. Flexion body jacket

It is the most commonly used to treat low back pain.

The purpose of this cast is to provide three point fixation,

straightening increased lordosis of lumbar spine, increasing
intraadominal pressure by compression on the abdomen.

The patient should remain fairly active and do both

abdominal and spinal muscle strengthening exercises while
in the cast.
8
2. Hyperextension body jacket

It is commonly used for the treatment of compression

fractures of spine in the thoracolumbar region.

3. Plaster bolero

Used in treating unstable fractures of clavicle that requires

hyperextension of shoulders to maintain the position.

4. Minerva cast

5. Plaster velpu

Is generally used only as a soft tissue dressing to immobilize

the shoulder or humerus.

6. Short arm cast

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 Can be used to immobilse the wrist and base of finger
metacarpals

7. Muenster short arm cast

Is used to immobilize the forearm & wrist when flexion-

extension can be done of the elbow but limited supination
and pronation.

8. Hanging arm cast

Used to treat humerus fractures

9. Gauntlet cast

Used to immobilize fractures of metacarpals of hand and for

minor injuries of wrist

INDICATIONS

1) Fracture in children: internal fixation is almost not

indicated in children except for displaced
intratrochanteric fractures, some avulsion fractures who
have severe life threatening multiple injuries. Children
have tremendous capacity to remodel bone as they
grow. Non union is rarely a problem in them. Majority of
children very quickly regain mormal ROM and strength.

10
 For these reasons, these fractures are always treated
with closed technique.

2) Undisplaced fractures

3) Poor bone quality: with aging population, osteoporosis

is becoming a common problem. Osteoporotic bone is
very difficult to fix internally and commonly therefore
non surgical methods are indicated in very elderly

4) Systemic contraindication to surgery

5) Local contraindications to surgery: severe skin lesion,

local skin infection or other soft tissue condition

CONTRAINDICATIONS

1) Pressure sores: most commonly over edges, at the edges of

the cast

2) Burns: as the exothermic reaction of setting takes place in

plaster and fiberglass materials, enough heat is generated
to cause a severe burn, particularly if there is no way for
heat to dissipate. Common in patients with sensory loss.

3) Allergic dermatitis

4) Vascular compromises, compartment syndrome and nerve

injury

5) Malposition

6) Stiffness, disuse, RSD

11
BONE SCREWS

A bone screw is used for internal fixation more often than any
other implant

Though it appears as a simple device, it has a great deal of

complex design.

It has four functional parts: Head, Shaft, Threads and Tip.

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HEAD

• The screw head serves as an attachment for the screw

driver.

• Is essential while removing and insertion of the screw.

• The undersurface of the screw is the countersink.

SHAFT

The shaft is the smooth part of the screw between the head and
the thread.

RUN-OUTS

It is the spot where the shaft ends and the thread begins.

THREAD

It is wrapped around the core which provides the main support of

the screw.

PITCH

It defines the distance between the adjacent threads

LEAD

The distance the screw will advance with each turn, the lead is
therefore equal to the pitch.

PRINCIPLE

It provides interfragmentary compression which improves

mechanical stability of internal fixation between bone fragments
by minimizing the effect of torsion, shear and bending forces.

FUNCTION

13
It is used either to fasten plates or similar devices on to the bones
or as lag screws, to hold together fragements of bones.

TYPES OF SCREWS

CORTICAL SCREWS

• It is a machine type of screw.

• The threads are smaller (in diameter) and are closely placed
( lower pitch).

• The core diameter is relatively large and provides the

necessary strength.

• The smaller pitch increases the holding power.

• Threads are cut in the pilot hole before the screw is inserted.

• The elastic reaction vital to hold the bone surfaces together,

comes from elastic deformation of the bone rather than the
screw.

• Advantage : more engagement of screw threads in to the

bone is possible because taps provide four cutting flutes,
micro- motion of bone is less likely to occur, therefore these
procedures better hold the screw

• Disadvantages: it require extra step in operative procedure

and because rather smooth track is established, it is more
likely to loosen by backing out when it is subjected to
cylindrical; stress.

14
CANCELLOUS SCREW

• It is a modified wooden type of screw.

• It has larger threads and a higher pitch as compared to the

cortical screws.

• The core diameter which is smaller than the shaft, provides a

greater surface area for purchase of the screw threads on
the bone.

• It is inserted in to an untapped pilot hole.

• Uses: used as fastening devices such as plates in

metaphyseal and epiphyseal areas

• Advantages:

i. Holding power in fine trabecular bone is more.

ii. Tapping is not usually required because cancellous

bone is fairly soft and easily deformed.

iii. As the screws penetrate, it compressesthe bone to

either side, thereby increasing the bone density in the

15
 immediate vicinity of the thread, this improves the
holding power.

iv. Typically they have smooth shank in poetion

immediately adjacent to screw head so that an
automatic lag effect occurs without having to overdrill
the near cortex

• Disadvantage: when used without a plate they are more

prominent

CANNULATED SCREWS

• It is used for precise insertion in metaphyseal or epiphyseal

site over a guide wire.

• This reduces the problem of having to remove and reposition

an incorrectly placed screw.

• The guide wire also maintains the reduction and controls the
fracture fragments.

• Cancellous cannulated screws come in large and small sizes.

• Large screws are used to fix fractures of the femoral neck,

femoral condyle and tibial plateau.

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 • Small cannulated screws are used for distal radius, distal
humerus, distal and proximal tibia, carpals and scaphoid.

• Advantages: it needs less soft tissue dissection.

• Disadvantages: screws are weaker than non cannulated

screw particularly in small fragement size, they break more
easily when removal is attempted

THE HERBERT SCREW

• It is an specialized implant to achieve intrafragmentary

compression.

• In this unique device there is no head and threads are

present at both the ends of the screws with a pitch
differential between the leading and trailing screws.

17
 • Principle: intrafragmentary compression is achieved the
differences in the threads.

LAG SCREW

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 • It is the most effective way to achieve compression
between two bony fragments.

• It pulls the fragments together producing pressure at the

fracture line.

• Compression between the fracture fragments increases

the friction force so that interfragmentary motion is less
likely and therefore strengthens the structure.

• It achieves this by producing purchase on the distal

fragment while being able to turn freely in the proximal.

• Lag screw principle:

1. The screw must glide freely through the near

fragment and engage only the far fragment.

2. Whenever a screw crosses a fracture line it should be

inserted as a lag screw.

3. Two small screws produce a more stable fixation

than one large screw.

• The lagging technique can be applied to virtually all of

screws. In diaphyseal fractures a cortical screw is applied as
a lag screw.

• In epiphyseal or metaphyseal fractures cancellous screws

are applied.
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 • To effect maximal interfragmentary compression, lag screw
must be inserted in to the centre of the fragments and at
right angles to the fracture plane.

• Uses: in communited fractures, in metaphyseal area, to

achieve inter fragemental compression & stability.

• Disadvantages: it does not provide great deal of strength, if

while doing screw is inserted at an acute angle to fracture
plane then as it is tightened it introduces a shearing moment
and tends to displace the fragements causes loss of
reduction.

NAILS

INTERLOCKING NAILS

The intramedullary nailing techniques which are in common use

today. They are derivd mainly from Gerhard kuntsher.

Biomechanics: interlocking nails act as internal splints, serving as

load sharing devices stabilizing fracture fragements and
20
maintaining alignment while permitting slight bending during
functional activities, a thicker nailmay not allow bending by
allowing the movement of the adjacent joints, rehabilitation is
concurrent with treatment and stress shielding is minimal.

FRACTURE HEALING FOLLOWING NAILING

The peripheral circulation is generally maintained however, the

remaining process causes additional damage. It has been
observed that the small vessels grow in to the existing gaps
between the bones and the nail is an astonishingly short period of
time from where they penetrate in to the neighbouring
malperfused cortical bone and initiate endosteal bone formation.

Tilt nails gives the best results. The healing of well done closed
nailing and the shaft of tibia or the femur depends on the fracture
geometry and the level of fracture healing in a biological process
helped by mechanical stability.

INDICATIONS

1) All closed fractures of tibia

2) Aseptic non union

3) Pathological fractures

4) Deformity correction

5) Septic non union

6) Open fractures up to grade 3 tibial diaphyseal fractures

7) Limb lengthening procedures

8) Arthrodesis

21
• Advantages:

 Fractures fixed with intramedullary nails displayed higher

values for blood flow in the whole bone and at the fracture
site which remained elevated for longer time than these
managed with rigid plate fixation.

 For the weight bearing bones, intramedullary nailing is a

fixation because the location of the rod in intramedullary
canal virtually guarantees proper axial alignment

• Disadvantages

 The size of the intramedullary canal may limit the size of the
nail that can be used, this limits the bending strength of the
nail unless extensive reaming performed.

 Intramedullary nails particularly reamed nails interfere with

the endosteal blood supply, which makes up to 90% of
vascular supply to diaphysis of long bone.

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TYPES OF NAILS

1. REAMED NAILS

The classic reamed nail is hollow open section nail of

kunscherz. Reaming provides precise fit for nail in
intramedullary canal, thereby reducing the incidence of
nail in correction and improving the stability of the
fixation.

Reaming permits the use of longer nails which are

stronger than the smaller ones.

2. Non reamed nails

Single, non reamed, non locking nails have been designed

for most of long bones including femur, tibia, humerus
and foreram bones.

Single non reamed nails are easy to insert and associated

with improved preservation of endosteal blood supply and
rapid revascularization.

There disadvantages include an increase likelihood of

impaction during driving and because smaller nails must
be used.

3. Locking nails

They have single non locking nails absolute. The only

advantage of non locking single nails are their simplicity
and low cost.

4. Specialized nails

These are based on locking principle;

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 i. Gamma nails: developed in a short designs for
fixation of intratrochanteric fractures. Now they are
available in long devices that function like
reconstructive nail.

ii. Alta nails: used in femur subtrochanteric fractures.

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PINS

STEINMENN PINS

Steinmann pins are rigid stainless steel pins of varying lengths, 4-

6mm in diameter. After insertion a special stirrup is attached to
the pin. The bohler stirrup allows the direction of the traction to
be varied without turning the pin in the hole.

They are now a days threaded rather than the ones that are
smooth, smooth pins tend to loosen rapidly, so they slip in and
out, leading to soft tissue infection or osteomylitis of bone.

Indications

• They are mainly used for traction through the femur, tibia,
calcaneus

Complication

• Pin traction infection

• Ligamentous damage

• Damage to epiphyseal growth plates when used in children

• Depressed scars

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 DENHMANS PIN

The denhman pin is identical to Steinmann pin accept for a

short raised threaded length situated towards the end.

This threaded portion engages the bone cortex and reduces

the risk of pin sliding.

This type of pin is particularly suitable for use in cancellous

bone such as calcaneus or osteoporotic bone.

NEUFELD PIN

It is advantageous in elderly, medically unstable patients

with impacted and non displaced femoral neck fractures.

TENSION BAND WIRING

26
• If a fracture is to unite, it requires mechanical stability, which
is obtained by compression of the fracture fragments.
• Conversely, distraction or tension interferes with fracture
healing. Therefore, tension forces on a bone must be
neutralized or, more ideally, converted into compression
forces to promote fracture healing.
• This is especially important in articular fractures, where
stability is essential for early motion and a good functional
outcome.
• In fractures where muscle pull tends to distract the
fragments, such as fractures of the patella or the olecranon,
the application of a tension band will neutralize these forces
and even convert them into compression when the joint is
flexed.
• Similarly, a bone fragment can be avulsed at the insertion of
a tendon or ligament.
• Examples include the greater tuberosity of the humerus the
greater trochanter of the femur, or the medial malleolus.
Here, too, a tension band can reattach the avulsed fragment,
convert tensile force into compression force allowing
immediate motion of the joint.

27
EXTERNAL FIXATORS
28
In the management of limb injuries, external skeletal fixations,
wide variety of applications, now has a firm place in the
armamentarium of technique available to trauma surgeon.

External fixations is a method of immobilizing fractures by means

of pins passed through the skin and bone.

In external fixation a minimum of metal exists inside the tissues,

and the fracture elements are will realigned, distracted or
compressed.

INDICATIONS:

1. Compound fractures

2. Closed fractures with severe associated soft tissue injuries;

compartment syndrome

3. Limb injuries requiring plastic and vascular procedures.

4. Stress shielding device to protect internal fixation

5. Infected non unions

6. Poly traumatized patients

7. Selected fractures of the pelvis

There are two types main types of external fixators: Pin fixator
and Ring fixator

PIN FIXATOR

• They are applied quickly to stabilize most diaphyseal

fractures.

29
 • Also wound access is adequate for management of soft
tissue injuries.

• Disadvantages:

1. The fracture needs to be reduced before constructing

the frame.

2. The presence of a fixed bar, limits adjustability of the

frame to control angulatory and rotatory deformities,

3. It does not allow axial loading at the fracture site.

4. There is high incidence of delayed union and non union.

5. Not suitable for ankle and pelvis fractures.

RING FIXATOR

• In this mode of external fixator, the frames have a major role

to play in complex reconstructions.

• These frames replicate the structure of a long tubular bone

and are somewhat like exoskeletal.

30
• The bone is stabilized by tensioned wires acting like an
elastic band.

• The frame gives stability for the fracture.

• Fracture healing is better than in the pin fixator as weight

bearing produces micromovements that favour faster
healing.

• DISADVANTAGES:

1. They are heavy and cumbersome

2. It is a time consuming procedure

3. There is a risk of neurovascular damage as the pins and

wires transverse the entire thickness of the bone.

4. Oedema is a commoner occurrence in unilateral

frames.

• USES

31
 1. Progressive deformity correction

2. Limb lengthening and

3. Management of non union.

Basic componenets of an external fixator

• Bone screws or pins

• Clamps

• Couplings

• Central body

• Compression-distraction system

1. The pin (schanz screw, half pins)

• The stabilizing hold on a bone segment is obtained through a

specialized bone pin that does not pass much beyond the far
cortex

• This pin has threads at one end and a rounded tip at the
other end.

• The half pin is a main stay of the external fixator. It is a

modified cortical screw and it is only used as a hold fast, it
does not exert intrafragmentary compression as cortical
screws.

• A Steinmann pin is also used which passes through the bone.

2. The clamp

32
• It provides a connection between the pins and the other
components of the fixator.

• There are two types, in the first type an indivisual pin is

fastened to the frame by a single pin tube articulation. The
second type can attach a group of pins together and attach
them to the main frame.

3. The central body

• The central body, a connecting rod or a tube is the mian

structure of the fixator.

• Increasing the number of rods, increases the rigidity of the

frame.

4. Compression-distraction system

• The compression- distraction assembly can be fixed to the

main structure in special circumstances.

• These devices are useful to apply compression at the

fracture surface or bone interface.

5. Frames

• The three dimensional structure built with the components of

a fixator system is called a fixator frame, construct, or a
fixator configuration.

• Types of frame are: unilateral, unilateral uniplanar, unilateral

biplanar,bilateral, bilateral uniplanar, bilateral biplanar,
modular.

33
 Unilateral uniplanar frame

• It is a best suitable stabilization frame in regions where the

local topography, anatomy and functional considerations
make the erection of the double frame or a triangulated
assembly impossible.

• The stiffness of this frame in the saggital plane is is higher

than in the bilateral uniplanar.

• The increased stiffness neutralizes most bending forces

which tend to cause displacement of the fragements.

• Indications: The frame is useful in stabilising humeral shaft,

the ulna and radius and fracture femur and tibia.

• Advantage: Walking is greatly facilitated and the patient

can square or sit crossed legged, fewer skin entry holes
reduce the possibility of bacterial contamination and the
number of scars.

• Disadvantages: There is no possibility of improving the

reduction alignment once the frame is completed, also there
is vulnerability of the anterior tibial crest; should infection
occur the strongest portion of the tibia can be severly
damaged.

 Unilateral biplanar frame

• It is the most stable of the unilateral frames and it is well for

the treatment of tibial fractures since a large surface of that
bone is subcutaneous.

• Pins are inserted at various positions without going through

muscles, tendons, nerves or vessels.

34
• A unilateral biplanar frame is useful for prolonged application
of the fixator in the presence of bone loss or severe soft
tissue damage.

 Bilateral uniplanar frame

• Depending upon the stability produced by the lag screws,

the bilateral uniplanar frame is either applied with a axial
compression or used simply to neutralize bending and
shearing forces.

• In the presence of a bone defect or severe communition, one

cannot apply compression for fear of producing shortening.

• The stability of this frame is improved by prestressing the

Steinmann pins within each main fragement.

• The symmetry of the bilateral uniplanar assembly has offers

certain mechanical advantages over the unilateral uniplanar
frame, it almost completely eliminates lateral movements of
the fragements and it allows for uniform distribution of stress
on the cortices and the external structure of the frame.

 Bilateral biplanar frame

• It offers greater torsional stability than other frames, with

only a few additional pins.

• The frame is useful in the presence of a large bony defect

and in achieving arthrodesis of the knee and elbow.

• This configuration neutralizes the bending movements in the

ventrodorsal or saggital plane, which is of great advantage
in the postoperative mobilization of the lower extremity after
arthrodesis of the knee joint.
35
 Modular frame

• Unilateral uniplanar frame requires pins to be placed in a

particular order and does not allow any variation to
accommodate soft tissue conditions nor does it permit
secondary correction without new pin placement.

• In a modular frame which is a modification of the unilateral

uniplanar frame, the pins are inserted as local condition
demand.

• The modular frame gives unnprecendented freedom of pin

placement and permits the positioning of pins in different
planes according to the anatomy and nature of soft tissue
damage.

• An example of the usefulness of this frame is the external

fixation of the humerus, where damage to the radial nerve is
avoided by applying the pins in two planes at right angles to
each other.

36
BONE PLATES

Bone plates are like internal splints holding together the fracture
ends of the bone.

The bone plates can be classified in to four groups

1. Neutralization plates

2. Compression plates

3. Buttress plates

4. Condylar plates

NEUTRALIZATION PLATES

• A neutralization plate acts as a ‘bridge’

• PRINCIPLE:
37
 1. It transmits various forces from one end of the
bone to the other, bypassing the area of the
fracture.

• Functions:

1. Acts as a mechanical link between the healthy

segments of bone above and below the fracture,
such a plate does not produce any compression at
the fracture site.

2. Used in combination with a lag screw also

counteracts the torsional, bending, and shearing
forces that tend to disrupt the screw, allowing
mobilization of the extremity.

3. The most common clinical application of the

neutralization plate is to protect the screw fixation
of a short oblique fracture or a communited
fracture of a long bone.

COMPRESSION PLATES

• A compression plate produces a locking force across a

fracture site to which it is applied.
38
• This effect occurs according to newton’s third
law(action and reaction are equal and opposite).

• The plate is attached to a bone fragement. It is then

pulled across the fracture site by a device, producing
tension in the plate. As a reaction to this tension,
compression is produced at the fracture site across
which the plate is fixed.

• The direction of the compression force is parallel to the

plate.

• The role of compression plate

1. Compaction of the fracture to force together the

interdigitating spicules of bone and increase the
stability of the construct.

2. Reduction of the space between the bone

fragements to decrease the gap to be bridged by a
new bone.

39
 3. Protection of the blood supply through enhanced
fracture stability.

4. Friction, which at the fracture surfaces resists the

tendency of the fragements to slide under torsion
or shear. This is advantageous as plates are not
particularly effective in resisting torsion.

BUTTRESS PLATE

• FUNCTIONS

1. The mechanical function of this plate is to strengthen

(buttress) a weakened cortex.

2. It prevents the bone from collapsing during the healing

process.

3. It is designed with a large surface area to facilitate wider

distribution of the load.

• PRINCIPLE

1. In order to prevent shearing at the fracture site or

displacement of the fracture fragments bringing about
widening of the articular surface, it is necessary to
apply a plate from the diaphysis across the outer
surface of the metaphyseal-epiphyseal fragment.

2. Such a plate acts as a buttress or retaining wall. A

buttress plate applies a force to the bone which is
perpendicular to the flat surface of the plate.
40
 • A buttress plate is used to maintain the bone length or to
support the depressed fracture fragments.

• Commonly used in fixing epiphyseal and metaphyseal

fractures.

• There are two types of buttress plates T-plate or L-plate

• T-plate is used for fixation of the distal radius and tibial

plateau, also used to fix fractures of the tibial pilon and the
distal humerus.

CONDYLAR PLATE
41
• Its main application is in the treatment of intra articular
distal femoral fractures.

• FUNCTIONS:

1. It maintains the reduction of the major intra articular

fragments hence restoring the anatomy of the joint
surface.

2. It also rigidly fixes the metaphyseal components to the

diaphyseal shaft, permitting early mobility of the
extremity.

3. It can function as both the neutralization plate as well

as the buttress plate.

• A condylar plate is used to fix a proximal femoral osteotomy

and intercondylar fracture of the femur.

42
REFERENCES

1. The elements of fracture fixation:- Anand. J. thakur

2. Maheshwari: essentials of orthopaedics

3. Michael chapman: chapman’s orthopaedic surgery

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