Locking Plates: General Concepts : Wheeless' Textbook of Orthopaedics

- Locking Plates: LCP Locking Compression Plate.
        - locking screws makes plate fixation more resistant to failure from screw loosening and pullout;
        - for failure to occur, a locking screw construct will fail as a unit as opposed to sequential screw failure with non locking plates;
        - far cortical locking:
               - over drilling the near cortex;
               - goal is to promote callus on the near cortex;
                       - Far Cortical Locking Can Reduce Stiffness of Locked Plating Constructs While Retaining Construct Strength
                       - Far Cortical Locking Can Improve Healing of Fractures Stabilized with Locking Plates
                       - Dynamic Fixation of Distal Femur Fractures using Far Cortical Locking Screws: A Prospective Observational Study.

        - hybrid locking
               - uses combination of non locking (dynamic compression screws) and locking screws;
                         - Locked Plating in Practice: Indications and Current Concepts
                         - "Shimming" a locking plate with washers to correct axial alignment.
                         - Effects of Hybrid Plating With Locked and Nonlocked Screws on the Strength of Locked Plating Constructs in the Osteoporotic Diaphysis

- pitfalls
      - hardware failure:
                - repeated stresses concentrated over the fracture site can exceeded the mechanical stiffness of the locked plate, leading to plate bending or plate fracture;
                - use of a longer plate can better distributed the stresses associated with weightbearing at the fracture site;
      - references:
                - Locking compression plate loosening and plate breakage: a report of four cases.
                - The Influence of Fracture Fixation Biomechanics on Fracture Healing