Choosing the Right Bone Plate

What are the main types of bone plate?

There are three main types of bone plate: compression plates, arthrodesis plates and osteotomy plates.

Compression plates: these plates are used for fractured bones.

Arthrodesis plates: these plates are used to stabilize or immobilize a damaged joint.

Osteotomy plates: these plates are used for bone lengthening and to correct certain orthopedic deformities.

For each application, a bone plate should enable:

Fracture reduction
to restore anatomical relationships

Fracture fixation
to ensure absolute or relative stability

Early mobilization
of the affected area to allow for the patient’s full rehabilitation

Preservation of the vascularization
of soft tissue and bone

Arthrex osteotomy plates

What criteria should you take into account when choosing a bone plate?

There are several criteria to consider when choosing a bone plate such as the application, whether the plate is locking or not, the geometry of the holes and the materials it is made of.

Application: compression, arthrodesis or osteotomy

The part of the bone concerned

Side concerned
(right or left)

Locking plate or not

Hole geometry

Plate profile

Shape and size of the plate

Slotted or smooth plate

Materials

Depuy Synthes tibia compression plate

Bones plates: locking or not?

There are locking bone plates that are threaded at the screw holes, and non-locking plates. Both have their own advantages.

Advantages of
locking compression plates:

No bone contact is required: a locking bone plate does not need to be in contact with the underlying bone, reducing the need for extreme precision when placing the plate to achieve sufficient fracture reduction.

Less bone damage: the locking plate system causes less damage to the underlying cortical bone than conventional bone plates that compress the plate onto the cortical bone.

Low risk of loosening screws: there is a lower risk of screws loosening when using locking bone plates. The risk of inflammatory complications due to loosening material is also therefore reduced.

The main advantage of
non-locking compression plates
is the
greater angulation possible
when screwing them in.

Symmetrical or non-symmetrical bone plates?

There are two main hole geometries for bone plates: symmetrical and asymmetrical. Here are their respective characteristics:

Symmetrical holes: most compression plates have symmetrical holes. This allows compression in both directions.

Asymmetrical holes: some compression plates, however, include asymmetrical holes that allow for unidirectional compression of the bone. These plates consist of a middle section that is placed at the level of the fragments to be compressed.
They often offer greater freedom in terms of positioning.

What materials are bone plates made of?

Stryker bone plate for mandibular reconstruction

The main materials used for bone plates are metal and bioresorbable polymers.

Metal: bone plates can come in stainless steel or titanium.

Bioresorbable polymers: there are bone plates made of trimethylene carbonate (TMC), polyglycolic acid (PGA), polylactic acid (PLA) and its derivatives (LPLA, DLPLA).

Metal or resorbable bone plates?

Below you will find a list of the advantages and disadvantages of metal and resorbable bone plates.

Metallic compression plates:

Advantages:

High mechanical resistance to torsion and crushing

The most widespread (wide availability of plates and screws)

Disadvantages:

Risk of allergies and infections

The mutagenic effects certain metals can have on tissue

Risks of interference with imaging techniques (X-ray or MRI)

Significant palpability of the implant

Sometimes it is necessary to operate again to remove the plate and screws

Sensitivity to temperature variations

Resorbable compression plates:

Advantages:

Modular plates (can sometimes be cut if necessary before the intervention)

Disadvantages:

Decreased mechanical resistance

Less stability of the plate and screws

Long resorption process

Use limited to certain osteosynthesis procedures

Limited choice of biodegradable materials

Inion resorbable compression plate