Evolution of fracture treatment with bone plates

Internal fixation of bone fractures by plate osteosynthesis has continuously evolved for more than 100 years. The aim of internal fracture fixation has always been to restore the functional capacity of the broken bone. The principal requirements of operative fracture management, those being anatomical fracture reduction, durable fixation, preservation of biology, promotion of fracture healing and early patient mobilization, have always been crucial but were accomplished to different extents depending on the focus of the specific fracture fixation principle employed. The first successful approach for internal fracture fixation was anatomic open reduction and interfragmentary compression. This secured the fracture fragments, maintained alignment and enabled direct healing of the fracture fragments. However, the highly invasive approach inflicted an immense amount of biologic stress to the area surrounding the fracture site. Modern preferably anatomically pre-contoured locking plates with relative stability of the bone-implant construct enable durable fixation while allowing a less invasive approach that preserves the biology at the fracture site. In contrast to conventional plating, locked plating provides a certain amount of flexibility, which is required to induce the formation of periosteal callus through interfragmentary motion. Most recently the concept of dynamic plating was introduced, which aims to induce more controlled interfragmentary motion and active stimulation of periosteal callus formation. This review article describes the historic development of plating from conventional plating to locked and dynamic plating.