dr uzair

2.  Rigid internal fixation
 Non rigid internal fixation
 Functionally stable fixation

3. “Any form of fixation which is strong
enough to prevent interfragmentary
motion across fracture when actively
using the skeletal structure”

5. “Any form of bone fixation that is not strong
enough to prevent interfragmentary motion”
Example:
Transosseous wiring

6. “Forms of non rigid skeletal fixation that
allow strong enough to allow active use of
skeleton during healing phase but not strong
enough to prevent interfragmentary fixation”
Example:
Single adaptation mini
plate at angle

7.  1886: Hansmann developed a retrievable bone
plate
 1932: Key employed crude compression plates for
tuberculosis of tibia
 Late 1960’s: Luhr, Mittelmeier introduced sliding
hole concept
 1970’s: Luhr, Spiessl and Champy’s introduction of
compression plates for mandibular fractures
 Late 1970’s: EDCP’s introduced, Mini and recon
titanium plates
 Early 80’s: Bioresorbable plates

8.  Arbeitsgermeinschaft fűr Osteosythenfragen
 Founded in Switzerland in 1958
 AO-CMF
 A non profitable organization funded by its three daughter
companies
 Creates guidelines, new products and promotes research
on internal fixation
 Includes human as well as veterinary IF

9.  Vanadium
 Stainless steel
 Vitallium
 Titanium
• Development of 18-8 SS for
surgical implants
• Introduction of 316L SS in 1943
• Still in use, although available
materials are limited
• Proprietary name of Co-Cr
alloy
• Developed by Albert W.
Merrick in 1932
• Use abandoned in mid 60’s
• Introduced by Sherman
• soft, silvery gray, ductile
transition metal
• Imparts aggressive soft
tissue reaction

10.  CP-Ti used (commercially pure Titanium)
 Divided into grades I-IV depending upon oxygen contents
 Extremely insoluble, inert and biocompatible
 High corrosion resistance due to spontaneous formation of thin
oxide layers
 Anodized, electrolytically passivated
 Non ferromagnetic
 Titanium alloys available: only where special high strength
requirements (not in CMF)

11.  Screws
 Plates
› Compression plates
› Adaptation plates Mini, Micro
› Universal plates
› Reconstruction plates

12. Head
Shank/ neck
Threads
Screw point
Head diameter
Thread pitch
Thread diameter
Core diameter

13.  Different diameters / lengths + Emergency screws
 Manner of tapping
 Self tapping
 Non tapping
 Self drilling
 Screw recess
 Cruciform
 Hexagonal
 Manner of locking
 Locking
 Non locking

14. Craniofacial
plates

15.  Ability to compress fracture
segments
 Helps in direct bone union
 Little role in midface
 Variants:
› LC-DCP (Limited Contact)
› E-DCP (Eccentric)

17.  Adapt to the cortical surface of bone
 Friction between bone and plate interface
leads to functional stability
 Types:
› Mini plates (mandible + midface)
 1.5 mm and 2.0 mm
› Micro plates (midface)
 1.0 mm and 1.3 mm

18.  Thickness 0.9 mm
diameter 2.0 mm

20. Mandible 2.0 mm adaptation
plate and screw
Midface 2.0 mm adaptation
plate and screw

21. Mid face
• Mini
• Micro

22.  Available in 1.3 and 1.0mm
 Thickness of plate 0.5 mm or below
 Less projection
 Suitable for paper thin bones of midface
 Provide limited stability

25. Universal plates

26. Universal Plates
 Plate thickness 2.0 mm
 Screw core dia 2.4 mm
 Works like adaptation plate
 Indicated where additional stability is
required

27. Reconstruction Plates

28. The “RECON” Concept
1. ≥ 2.5 mm plate thickness
2. ≥ 2.4 mm core diameter of screw
3. ≥ 3 screws on each side
4. Bicortical

29. Types
 Non locking recon plates
 Uni lock recon plates
› Both available in 2.4mm and 2.7 mm systems, plate
thickness 2.5 mm and 3.0 mm
 THORP (Titanium HOllow screw Recon Plate)
› 4.0mm osteointegrated system, plate thickness 3.2mm

30. Unilock Recon

31. Difference between non locking and locking recon
plates

33.  Recon plate with condylar head
 Not approved by FDA, available in other countries

36. Lag Screw
 Simple, quick and cheap
 Provides rigid fixation
 Concept lies in method not the
screw
 Gliding hole in one segment,
thread hole in other
 Always perpendicular to fracture
line

38. Orbital mesh, plate

40. Drill Bits
 Contain 2-3 flutes
 Diameter corresponds to core
diameter
 Coupling varies, depending
upon system
 Can be with or without stop
 Care:
› No contact with metals during
drilling
› No bending forces
› Continuous irrigation

41. Depth Gauge
 For bi-cortical screws
 Insert, pull, engage, measure

42. Screw tap
 For non self tapping screws
 Useful in high corticated areas of bone

46. Thank you