Fixed angle Implants are made in DSC or dynamic condylar plate 95°, it can also be used in MIPO majorly with the fractures of the distal femur and proximal femur. At the time of the insertion of the chisel, it is required to determine the sagittal alignment of the condylar plate so that it becomes technically easy to use. With the rotation of condylar screws, the sagittal alignment of DCS can be adjusted. This plate is easy to insert even through a small incision and is more modular in the application.
Indications for insertion of locking head screws in an LCP
The locking head screws in the LCP can be inserted in case of the Microlock Hand Fracture Plate, osteoporotic fracture, etc. which is also a good indication for the mono cortical application of self-tapping and self-drilling. It is also indicated with the metaphyseal and periarticular fractures.
Indications for insertion of standard screws in an LCP
When it is required to achieve interfragmentary or axial dynamic compression then it is used. It is used to assist the fracture site with reduction when the bone fragment is pulled towards the bone plate while using standard screws. In the case of periarticular fractures, it is indicated to avoid the penetration which is almost unavoidable in case of the use of fixed angle LHS. In such types of cases through the dynamic compression unit of hole combination, the insertion of standard screws is made parallel towards the articular surface.
Choice of Implants different bone segments
After clearing the concept of conventional plates (DCP or LC-DCP) and LHS properly it becomes easy to decide which is the best suited Orthopaedic Implants for the fracture in various bone segments.
Diaphyseal fractures
In this kind of fracture, both conventional plates and LCP can be used. For the fractures in osteoporotic bones, it will be more suitable to use the LCP with LHS. The normal anterior bowing of the femur can be considered in the case of the Femoral shaft fracture and the straight plate should be countered on the same. At the metaphyseal area where the plate end extends either at distal or proximal the accurate contouring of the plate should be done to match the bone surface area.
Metaphyseal fractures
It is completely suitable to use the metaphyseal LCP, as being a straight plate, the contouring is required. At one end such plates acquire thin sections while on the other they have thick sections. For easy contouring, the thinner section of the plates is designed accordingly which is also less prone towards causing the irritation of soft tissue. For the application in the diaphysis, the thicker section of the bone plate is designed. If there is any sort of risk due to which the penetration of distal LHS can be made to the joint surface due to the fixed angle then there can be alteration or decrease in the bending of the plate that can be done.
The plate can also be shifted slightly away from the articular surface for avoiding such kinds of problems. In the part of dynamic compression, alternatively, the insertion of standard screws can also be made which is parallel to the articular surface. It will be good to use the pre-designed and pre-shaped LCP, if available. There is no requirement for intraoperative contouring as these plates are contoured already.
The realignment of the fracture can also be a template with the contouring of the plate. In the case of the distal femur LISS, the surgeon should be familiar with the situation that some patients have excessive varus bowing in the corona plane or interior bowing in the sagittal plane, the prediction can be made for any such case. The proper alignment between the plate and bone is required as it can also lead to the erroneous application of Implants. The use of conventional fixed Implants like dynamic condylar plate 95°or DCS can also be done in the case of Fracture of the proximal or distal femur.
Articular fracture with extension into the metaphysis/diaphysis
The major treatment principles for the intra-articular fractures are stable fixation with lag screws and anatomical reduction. With the help of arthrotomy, the reduction can be achieved with the help of an image intensifier or arthroscope.
With the help of Minimally invasive techniques, the articular blocks can be fixed to the metaphysis. In the case of the metaphysis fracture, any of the above-used implants can be considered.