eMedicine Specialties > Orthopedic Surgery > Trauma

General Principles of Internal Fixation: Multimedia

Author: Ronald Lakatos, MD, Assistant Professor, Department of Orthopedics, Ohio State University
Coauthor(s): Michael A Herbenick, MD, Assistant Professor of Orthopedic Surgery and Sports Medicine, Wright State University School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Miami Valley Hospital
Contributor Information and Disclosures

Updated: Nov 6, 2009

Multimedia

Common screw.
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Media file 1: Common screw.
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Common screw.

Common screw.

The screw thread is defined by its major or outsi...
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Media file 2: The screw thread is defined by its major or outside and minor or root diameters, pitch, lead, and number of threads. Bottom: Screw head drive types.
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The screw thread is defined by its major or outsi...

The screw thread is defined by its major or outside and minor or root diameters, pitch, lead, and number of threads. Bottom: Screw head drive types.

Top: Biomechanics of cannulated and noncannulated...
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Media file 3: Top: Biomechanics of cannulated and noncannulated screws. Bottom: Ideally, lag screw fixation produces maximum interfragmentary compression when the screw is placed perpendicular to the fracture line.
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Top: Biomechanics of cannulated and noncannulated...

Top: Biomechanics of cannulated and noncannulated screws. Bottom: Ideally, lag screw fixation produces maximum interfragmentary compression when the screw is placed perpendicular to the fracture line.

Optimal inclination of the screw in relation to a...
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Media file 4: Optimal inclination of the screw in relation to a simple fracture plane.
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Optimal inclination of the screw in relation to a...

Optimal inclination of the screw in relation to a simple fracture plane.

T-lag screw.
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Media file 5: T-lag screw.
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T-lag screw.

T-lag screw.

Conventional plate screws.
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Media file 6: Conventional plate screws.
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Conventional plate screws.

Conventional plate screws.

Locked plate screws.
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Media file 7: Locked plate screws.
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Locked plate screws.

Locked plate screws.

Dynamic compression principle: The holes of the p...
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Media file 8: Dynamic compression principle: The holes of the plate are shaped like an inclined and transverse cylinder. Like a ball, the screw head slides down the inclined cylinder. Because the screw head is fixed to the bone via the shaft, it can only move vertically relative to the bone. The horizontal movement of the head, as it impacts the angled side of the hole, results in movement of the bone fragment relative to the plate and leads to compression of the fracture.
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Dynamic compression principle: The holes of the p...

Dynamic compression principle: The holes of the plate are shaped like an inclined and transverse cylinder. Like a ball, the screw head slides down the inclined cylinder. Because the screw head is fixed to the bone via the shaft, it can only move vertically relative to the bone. The horizontal movement of the head, as it impacts the angled side of the hole, results in movement of the bone fragment relative to the plate and leads to compression of the fracture.

General principles of internal fixation.
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Media file 9: General principles of internal fixation.
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General principles of internal fixation.

General principles of internal fixation.

The shape of the holes of the dynamic compression...
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Media file 10: The shape of the holes of the dynamic compression plate allows inclination of the screws in a transverse direction of +7° and in a longitudinal direction of 25°.
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The shape of the holes of the dynamic compression...

The shape of the holes of the dynamic compression plate allows inclination of the screws in a transverse direction of +7° and in a longitudinal direction of 25°.

The structure of a limited-contact dynamic compre...
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Media file 11: The structure of a limited-contact dynamic compression plate.
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The structure of a limited-contact dynamic compre...

The structure of a limited-contact dynamic compression plate.

In the dynamic compression plate (A), the area at...
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Media file 12: In the dynamic compression plate (A), the area at the plate holes is less stiff than the area between them. During bending, the plate tends to bend only in the areas of the hole. The limited-contact dynamic compression plate (B) has an even stiffness without the risk of buckling at the screw holes.
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In the dynamic compression plate (A), the area at...

In the dynamic compression plate (A), the area at the plate holes is less stiff than the area between them. During bending, the plate tends to bend only in the areas of the hole. The limited-contact dynamic compression plate (B) has an even stiffness without the risk of buckling at the screw holes.

The application of the drill guides depends on th...
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Media file 13: The application of the drill guides depends on the proposed function of the screw. A: Neutral position. B: Compression.
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The application of the drill guides depends on th...

The application of the drill guides depends on the proposed function of the screw. A: Neutral position. B: Compression.

The 3.5 one-third tubular plate is 1 mm thick and...
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Media file 14: The 3.5 one-third tubular plate is 1 mm thick and allows for limited stability. The thin design allows for easy shaping and is primarily used on the lateral malleolus and distal ulna. The oval holes allow for limited fracture compression with eccentric screw placement.
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The 3.5 one-third tubular plate is 1 mm thick and...

The 3.5 one-third tubular plate is 1 mm thick and allows for limited stability. The thin design allows for easy shaping and is primarily used on the lateral malleolus and distal ulna. The oval holes allow for limited fracture compression with eccentric screw placement.

Angled or blade plates are useful in repair of me...
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Media file 15: Angled or blade plates are useful in repair of metaphyseal fractures of the femur, but their popularity has declined with the rise of sliding screw plates and locking plates. Proper insertion requires careful technique, with the blade inserted with consideration for 3 dimensions (varus/valgus blade angulation, anterior/posterior blade position, flexion/extension rotation of blade/plate).
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Angled or blade plates are useful in repair of me...

Angled or blade plates are useful in repair of metaphyseal fractures of the femur, but their popularity has declined with the rise of sliding screw plates and locking plates. Proper insertion requires careful technique, with the blade inserted with consideration for 3 dimensions (varus/valgus blade angulation, anterior/posterior blade position, flexion/extension rotation of blade/plate).

Reconstruction plates are thicker than third tubu...
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Media file 16: Reconstruction plates are thicker than third tubular plates but not quite as thick as dynamic compression plates. Designed with deep notches between the holes, they can be contoured in 3 planes to fit complex surfaces, as around the pelvis and acetabulum. Reconstruction plates are provided in straight and slightly thicker and stiffer precurved lengths. As with tubular plates, they have oval screw holes, allowing potential for limited compression.
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Reconstruction plates are thicker than third tubu...

Reconstruction plates are thicker than third tubular plates but not quite as thick as dynamic compression plates. Designed with deep notches between the holes, they can be contoured in 3 planes to fit complex surfaces, as around the pelvis and acetabulum. Reconstruction plates are provided in straight and slightly thicker and stiffer precurved lengths. As with tubular plates, they have oval screw holes, allowing potential for limited compression.

Tension-band principle.
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Media file 17: Tension-band principle.
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Tension-band principle.

Tension-band principle.

Tension-band principle at the femur.
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Media file 18: Tension-band principle at the femur.
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Tension-band principle at the femur.

Tension-band principle at the femur.

Blk screws.
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Media file 19: Blk screws.
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Blk screws.

Blk screws.

More on General Principles of Internal Fixation

References
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References

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Further Reading

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Keywords

broken bone, fracture, open fracture, open reduction and internal fixation, ORIF, bone screws, pretapped screws, self-tapped screws, pull-out strength, plate fixation, Kirschner wires, K-wires, Steinmann pins, dynamic compression plates, DCP, dynamic compression screw, limited-contact dynamic compression plates, LC-DCP, intramedullary nails, IM nails, biodegradable fixation, biodegradable implants

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Contributor Information and Disclosures

Author

Ronald Lakatos, MD, Assistant Professor, Department of Orthopedics, Ohio State University
Ronald Lakatos, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Michael A Herbenick, MD, Assistant Professor of Orthopedic Surgery and Sports Medicine, Wright State University School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Miami Valley Hospital
Michael A Herbenick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

James F Kellam, MD, Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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