Compression plate position. Extraperiosteal or subperiosteal?

Although compression plate fixation of diaphyseal long bone fractures is accepted treatment, surgical exposure and plate position in relation to the periosteum are controversial. Histologic, roentgenographic, and biomechanical methods were applied to investigate quality and chronology of healing in radial and ulnar fractures in adult dogs. Plate position was extraperiosteal in one limb and subperiosteal in the contralateral limb. There were no statistical differences in roentgenographic or histologic studies of healing between the two techniques, nor were significant statistical differences noted when comparing linear load, maximum load at failure, slope of the linear portion, energy absorbed to failure, stress, modulus of elasticity, strain at maximum linear load, strain at maximum load, and strain at failure. Thus, there was no appreciable difference in fracture healing between subperiosteal and extraperiosteal exposure with compression plate fixation of diaphyseal fractures in dogs. However, subperiosteal exposure is preferable because it is less likely to injure surrounding soft tissues.