when non-locking plates are preferred over locking plates during fracture surgery

1. When Are Non-Locking Plates Preferred Over Locking Plates During Fracture Surgery? In the ever-evolving world of orthopedic surgery, choosing the right implant is just as critical as the surgical technique itself. Among the most debated decisions in fracture management is whether to use a locking plate or a non-locking plate. While locking plates have become increasingly popular thanks to their biomechanical advantages, non-locking plates haven’t lost their place, and for good reason. So, when exactly do surgeons prefer non-locking plates over locking plates during fracture surgery? Let’s explore this decision from a practical, clinical point of view. Understanding the Basics ● Locking plates feature screw holes that allow the screws to "lock" into the plate, creating a fixed-angle construct. This is especially helpful in osteoporotic or comminuted fractures. ● Non-locking plates rely on friction between the plate and bone. The screws pull the plate tightly to the bone surface, creating compression. Both have their place, but the preference depends on the fracture pattern, bone quality, and surgical goals.

2. Situations Where Non-Locking Plates May be Used During Fracture Repair 1. When Bone Quality Is Good In patients with healthy, dense bone, often younger individuals or those without osteoporosis, non-locking plates offer excellent stability. The bone provides enough purchase for the screws to hold firmly, making locking mechanisms unnecessary. In these cases, non-locking plates not only do the job but also preserve flexibility for fine-tuning alignment. 2. For Simple, Non-Comminuted Fractures Fractures that are clean and straightforward, such as transverse or short oblique fractures, often respond well to non-locking plates. Surgeons can achieve precise anatomical reduction and apply compression across the fracture line, which encourages faster and stronger healing. Locking plates, in contrast, are designed more for bridge plating, holding multiple bone fragments together without direct compression. For simpler fractures, that would be overkill. 3. Cost Considerations Matter Let’s be honest: cost is a significant factor, especially in resource-limited settings or in patients without comprehensive insurance coverage. Non-locking plates are generally more affordable, both in terms of the implant and the required instrumentation. When the clinical scenario allows it, many surgeons choose non-locking plates to reduce the financial burden without compromising outcomes. 4. When Compression Across the Fracture Line Is Desired Locking plates are fantastic at maintaining position, but they don’t allow much in the way of fracture compression. That’s where non-locking plates shine. Using a dynamic compression hole in the plate design, surgeons can actively bring fracture ends together, promoting primary bone healing with minimal callus formation. This is ideal in areas like the forearm, where precise alignment is critical for function. 5. Minimizing Implant Stiffness While locking plates offer rigid fixation, that same rigidity can sometimes be a downside. Excessively stiff constructs may hinder the body’s natural healing process, particularly in cases where some micro-motion could promote callus formation. Non-locking plates, by allowing a degree of load sharing between bone and implant, may actually support biological healing in certain scenarios. 6. Surgeon’s Experience and Preference Like many tools in surgery, the choice of plate often comes down to surgeon familiarity and confidence. Some surgeons prefer the tactile feedback and intraoperative flexibility of non-locking

3. plates, especially for open reductions, where they can directly visualize and manipulate bone fragments. In Summary Locking plates may dominate the headlines, but non-locking plates remain a tried-and-true option in many fracture surgeries. They’re particularly preferred when: ● Bone quality is good ● Fractures are simple and stable ● Compression is key to healing ● Costs need to be kept in check ● Surgeon’s experience supports their use Ultimately, the decision isn’t about one being better than the other. It’s about choosing the right orthopedic implants and instruments for the right fracture in the right patient. That’s where surgical skill meets wisdom, and that’s what makes the difference. Contact Information Address:- WZ- 1, 2nd Floor, Phool Bagh, Ram Pura, New Delhi, 110035 INDIA Mobile:- +91 9810021264 Mail:- siioraorthopaedic@gmail.com Website:- https://www.siiora.com/ Source:- https://traumaimplants.science.blog/when-are-non-locking-plates-preferred-ov er-locking-plates-during-fracture-surgery/