PLATES AND

SCREWS:
An Overview
Presented by;Dr
Oteki Misiani
SCREW : BRIEF OVERVIEW
SCREW: INTRODUCTION

An elementary machine to change the

small applied rotational force into a
large compression force

Function
Holds the plate or other prosthesis to the
bone
Fixes the # fragments ( Position screw)
Achieves compression between the #
fragments (Lag screw)
 Screw: Parts
shank
4 functional parts
Head
Shaft
Thread
Tip
Head: Function

1. Means for applying torque with

a screwdriver

2. Acts as a stop (the

undersurface) i.e. countersunk
Head: Recess Types

1. Slotted
2. Cruciate
3. Philips
4. Hex/ Allen
5. Torx (eg Stardrive of Synthes)
Head: Countersink

Undersurface of head
Conical
Hemispherical
Morse-cone (steep): locking plates
Screw: Shaft/ Shank

Smooth link
Almost not present in standard
cortex screw
Present in cortical SHAFT SCREW or
cancellous screw
Screw: Run out

Transition between shaft and thread

Site of most stress riser
Screw break
Incorrectly centered hole
Hole not perpendicular to the plate
Screw: Thread

Inclined plane encircling the root

Single thread
May have two or more sets of threads

V-thread profile: more stress at sharp

corner
Buttress thread profile: less stress at
the rounded corner
Screw: Core Diameter

Narrowest diameter
across the base of
threads
Also the weakest
part
Smaller root
shear of
Torsional strength
varies with the cube
of its root diameter
Screw: Pitch and Lead

Distance between the adjacent threads

Cortex screw : small pitch 1.75mm
Cancellous screw: large pitch

Pitch also determines the lead

Lead :distance advanced in a complete
turn
Equals pitch in single threaded screw
Greater M.A. if smaller lead
Screw: Thread Diameter

Diameter across
the maximum
thread width
Afects the pull
out strength
Cancellous have
larger thread
diameter
Screw: Tip Designs

1. Self-tapping tip:
Flute
Cuts threads in the bone over which
screw advances
Cutting flutes chisel into the bone
and direct the cut chips away from
the root
Screw: 2.Non self
tapping
Lacks flutes
Rounded tip
Must be pre-cut in the pilot hole by
tap
Pre-tapped threads help to achieve
greater efective torque and thus
higher inter-fragmental compression
Better purchase
Screw: 3.Corkscrew tip

Thread forming tips

In Cancellous screws
which form own threads
by compressing the thin
walled trabecular bone
Inadequate for cortical
bone
 Screw: 4.Trochar Tip
Like self tapping
Displaces the bone as it
advances
Malleolar screw
Schanz screws
Locking bolts for IMIL
Screw: 5.Self drilling self
tapping
Like a drill bit
In locked internal fixator plate hole
Pre-drilling not required
Good purchase in osteoporotic and
metaphyseal area
Locking Screws vs
Cortical Screws
5.0 mm Locking Screw
4.5 mm Cortical Screw

4.4mm Core Dia. 3.5mm Core Dia.

Creates Fixed Angle Generates

Friction/Compression
PLATES

Introduction :
Bone plates are like internal
splints holding together the
fractured ends of a bone.
Mechanical functions of
plate
1. Transmit forces from one end to
another, bypassing and thus
protecting the area of fractures.

2. Holds the fracture ends together in

alignment throughout the healing
process.
Names of plates.

1. Shape (Semitubular, 1/3rd tubular)

2. Width of plate (Small, Narrow, Broad)
3. Shape of screw holes. (Round, Oval)
4. Surface contact characteristics. (LC,
PC)
5. Intended site of application (Condylar
Plate)
6. According to the function
Type of plate
Functional
Regardless of their length, thickness,
geometry, configuration and types of
hole, all plates may be classified in to
4 groups according to their function.

1. Neutralization plate.
2. Compression plates.
3. Buttress plate.
4. Tension band plates.
 Special Plates

T Plates
T&L Buttress plates
Lateral Tibial head buttress plates
Condylar buttress plate
Narrow lenthening plates
Broad Lengthening plate
Spoon plate
Clover leaf plate
NEUTRALIZATION PLATE
Acts as a ""bridge
protection
No compression at the
fracture site
neutralization plate is to
protect the screw fixation of
a short oblique fracture
a butterfly fragment
a mildly comminuted fracture
of a long bone
fixation of a segmental bone
defect in combination with
bone grafting.
The Neutralization Plate

Lag screws:
compression and
initial stability

Plate:
protects the
screws from
bending and
torsional loads
NEUTRALIZATION PLATE
 COMPRESSION PLATE
produces a locking force across
a fracture site
Newton's Third Law (action and
reaction are equal opposite)

plate is attached to a bone

fragment then pulled across the
fracture site by a device,
producing tension in the plate
direction of the compression
force is parallel to the plate
COMPRESSION

Static: does not change

with time

Dynamic: periodic partial

loading & unloading due to
functional activity
1. Tension Band wiring
2. Tension Band Plating
 LC-DCP

The structure of a limited-

contact dynamic
compression plate

1.Structured
undersurface
2.Undercut screw holes
3.Trapezoid cross
section
 The LC-DCP ofers additional
advantage

Improve blood circulation by

minimizing plate-bone contact
More evenly distribution of stifness
through the plate
Allows small bone bridge beneath the
plate
 Sizes of DCP
Name of plate Small Narrow Broad
Width 11 mm 13.5 mm 17.5mm
Profile 4 mm 5.4 mm 5.4 mm
Screw 2.7 , 3.5 cortex 4.5 mm cortex 4.5 mm cortex
screw and 4 mm screw & 6.5mm screw & 6.5mm
cancellous screw canellous screw canellous screw
Sizes of LCDCP
Name of plate Small Narrow Broad
Width 11 mm 13.5 mm 17.5mm
Profile 4 mm 5.4 mm 5.4 mm
Screw 2.7 , 3.5 and 4 4.5 mm & 6.5mm 4.5 mm & 6.5mm
mm cancellous canellous screw canellous screw
screw
Sizes of LCP
Name of plate Small Narrow Broad
Width 11 mm 13.5 mm 17.5mm
Profile 4 mm 5.0 mm 5.0 mm
Screw 4 mm locking 5 mm locking 5 mm locking
screw screw screw
 BUTTRESS PLATE
is to strengthen
(buttress) a weakened
area of cortex
The plate prevents the
bone from collapsing
during the healing
process.

A buttress plate applied

a force to the bone which
Bridge Plating :
Bridge Plating for
comminuted fracture

-instead of individually fixing

each fragment

-minimal disruption to blood

supply

-reduction is performed
indirectly

- compression is only
sometimes possible
Wave Plating :

Wave Plating for

non union
 Reconstruction Plates :

Can be bent and twisted in two

dimensions.
Decrease stifness than DCP.
Should not be bent more than 15.
Used were the exact and complex
contouring is required. eg. Pelvis,
Distal Humerus, Clavicle.
 Reconstruction plates are thicker than third tubular plates but not
quite as thick as dynamic compression plates. Designed with deep
notches between the holes, they can be contoured in 3 planes to fit
complex surfaces, as around the pelvis and acetabulum.
Reconstruction plates are provided in straight and slightly thicker and
stiffer precurved lengths. As with tubular plates, they have oval screw
holes, allowing potential for limited compression.
 One Third Tubular Plates :
Plates have the form of one third of the
circumference of a cylinder.
Low rigidity (1mm thick).
Oval holes Axial compression can be
achieved.
Uses Lateral malleolus, distal ulna,
metatarsals.
limited stability. The thin design allows for easy shaping
and is primarily used on the lateral malleolus and distal
ulna. The oval holes allow for limited fracture
compression with eccentric screw placement.
 LOCKING COMPRESSION PLATE (LCP)
Principle :
Angular-stability
whereas stability of
conventional plates is
friction between the
plate and bone

Screw locking principle

Provides the relative stability

Healing by callus
formation (Secondary
Healing)
LCP: internal external
fixator
 HOW MANY SCREWS ?
Hands-on experience suggests that, in the
humerus, screws grip seven cortices on each
side of the fracture ; in the radius and the ulna,
five; in the tibia, six, and in the femur, seven.

Bones No. of No. of Type of

Cortices Holes Plate
Forearm 5 to 6 Cortex 6 holes Small 3.5
Humeru 7 to 8 Cortex 8 holes Narrow 4.5
s
Tibia 7 to 8 Cortex 7 holes Narrow 4.5
Femur 7 to 8 Cortex 8 holes Narrow 4.5
Clavicle 5 to 6 Cortex 6 holes` Small 3.5
 HOW CLOSE TO THE FRACTURE SITE?

A screw, as a result, should not be

placed closer than one centimeter
from the fracture line.
 Timing of Plate Removal,
Recommendations for removal of
plates in the lower limb :
Bone / Fracture
Time after implantation in months
Malleolar fractures
8-12
The tibial pilon
12-18
The tibial shaft
12-18
The tibial head
12-18
 The femoral condyles
12-24
The femoral shaft: Single plate, Double Plate
24-36
From month 18, in 2 steps ( Interval 06 months)
Pertrochanteric and femoral neck fractures Upper
extremity
12-18
Optional
Shaft of radius / ulna
24-28
Distal radius
8-12
Metacarpals
4-6