Revolution in plate osteosynthesis: new internal fixator systems.

Conventional plating has been performed since the nineteenth century, and since then Lambotte, Danis, and others have developed new plate designs to restore fractured bones. At the early stage of plating, mechanical aspects were the focus, and the biology of the bone was sometimes neglected. During the 1980s the AO/ASIF group started to work on new plate designs to minimize the disadvantages of plating with respect to cortical perfusion. To overcome the negative effect of compression forces on the periosteum, a new generation of plates, or internal fixators, were created. The key to these internal fixators is the locking mechanism of the screw in the implant, which provides angular stability. This technical detail ensures that compression forces on the bone surface are not necessary to gain stability of the bone-implant construct, which improves fracture healing and provides an excellent holding force even in osteoporotic bone. The locking mechanism also makes the technique of percutaneous plating easier because, in contrast to conventional plates, the fragments are not pulled toward the implant by the locking screws. The new internal fixator systems [LISS (less invasive stabilization system) and LCP (locking compression plates)] offer new approaches to trauma surgery, especially for metaphyseal fractures.