A bone plate is a medical device used in orthopedic surgery to stabilize fractured bones, allowing them to heal properly. It acts as an internal splint, holding bone fragments in their correct anatomical alignment. Secured to the bone with screws, plates provide internal fixation, reducing the risk of improper healing and supporting the body’s natural healing processes.
How Bone Plates Stabilize Fractures
Bone plates provide internal fixation by mechanically supporting bone fragments. The stability they offer reduces movement at the fracture site, known as micromotion. Excessive motion can hinder new tissue formation, potentially leading to delayed healing or nonunion.
Plates achieve stability through several mechanical principles. Compression plating presses bone fragments together, increasing friction and stability, often achieved by contouring the plate and using specific screw techniques. Buttress plates, used for fractures near joints or on concave surfaces, prevent displacement or shortening under axial loads by supporting fragments and converting shear forces into compression. For highly fragmented fractures where direct compression is not feasible, bridging plates span the fracture site. These maintain overall bone length and alignment without disturbing individual fragments, promoting relative stability and callus formation, a type of secondary bone healing.
Different Bone Plate Designs
Bone plates are manufactured from biocompatible materials, most commonly surgical-grade stainless steel or titanium. These materials are durable and rarely cause allergic reactions. Plates come in various shapes and sizes, designed to fit the unique contours of different bones, from small hand bones to large bones like the femur.
Plate designs include non-locking and locking plates. Non-locking plates, also known as conventional plates, rely on friction between the plate and the bone, achieved by compressing the plate firmly against the bone surface with screws. This requires precise plate contouring to avoid altering fracture reduction when screws are tightened.
In contrast, locking plates feature threaded screw holes, allowing screws to “lock” directly into the plate. This creates a fixed-angle construct that provides enhanced stability, particularly useful for weaker bone (e.g., osteoporotic bone) or complex fractures, as it distributes the load across the entire implant-bone system. Many modern plates incorporate “combi holes” that accept both locking and non-locking screws, offering surgeons flexibility based on the fracture pattern and bone quality.
The Surgical Process and Healing
Implanting a bone plate is a surgical procedure, typically performed under general anesthesia. The process begins with an incision over the fractured bone. Bone fragments are then carefully “reduced,” meaning they are repositioned into their normal anatomical alignment. Once aligned, the bone plate is placed on the bone’s surface and secured with screws, which pass through holes in the plate and into the bone on either side of the fracture. This provides immediate fracture stability.
Following surgery, the initial healing period involves managing pain and facilitating early mobilization. Pain medication is commonly prescribed, and patients are often encouraged to begin gentle movement or weight-bearing as advised by their surgeon.
The bone plate supports the fractured bone, allowing natural healing to begin. This process involves hematoma formation at the fracture site, followed by recruitment of specialized cells that build new bone tissue. Over several weeks to months, a bone callus forms, gradually strengthening until it fully unites the bone fragments, typically taking 4 to 12 weeks or longer depending on the fracture and patient factors.
Living With and Removing Bone Plates
Many individuals live with bone plates indefinitely without issues. These implants are designed to remain in the body long-term. Patients generally adapt to the plate’s presence, and it typically does not interfere with daily activities or mobility once the bone has fully healed. In some cases, a patient might experience tenderness, discomfort, or prominence of the hardware, particularly if the plate is in an area with little soft tissue coverage or near a joint.
While many plates remain permanently, removal may be considered in certain situations. Reasons for removal include persistent pain or discomfort, irritation of surrounding soft tissues, or an allergic reaction to the metal. In rare instances, complications such as infection or non-union (where the bone fails to heal) may necessitate hardware removal or replacement.
The decision to remove a plate is a discussion between the patient and surgeon, weighing potential benefits against the risks of a second surgical procedure. If removal occurs, it typically involves a similar surgical approach to implantation, with a recovery period during which the bone regains full strength, often taking around 6 months.