New concepts for bone fracture treatment and the Locking Compression Plate

The operative treatment of bone fractures using plates and screws is a standard successful technique. Internal fixation with plates and screws leads to additional trauma and disturbance of the bone blood supply, which increases the risk of delayed union and infection. However, problems also are encountered in the fixation of osteoporotic bone. The locked internal fixator technique is an approach to optimize internal fixation. It aims at flexible elastic fixation to imitate spontaneous healing, including induction of callus formation. The technology supports what is currently called "minimally invasive plate osteosynthesis" (MIPO), which provides priority to biology over mechanics. An implant system called "Locking Compression Plate (LCP)" was developed, based on many years of experience with compression plating and good clinical results obtained with internal fixators, such as the Less Invasive Stabilization Systems (LISS). It combines the two treatment methods (ie, the compression plating and locked internal fixation methods) into one system. This chapter describes the basic principles of locked internal fixators and some clinical results with the LISS and LCP systems to illustrate the potential of these new systems.