Locked Versus Conventional Plate-Screw Fixation in Osteoporotic Bone: A Review

Locked plating and nonlocked plating rely on different biomechanical principles for success. Therefore, it should be no surprise that differences in performance can be observed, especially in specific clinical situations. The current consensus is that locked plating is beneficial in situations which require support of end segment fractures that are prone to varus/valgus collapse, in diaphyseal or metaphyseal fractures in osteoporotic bone, and in plating of fractures where, due to anatomic constraints, compression plates may not be placed on the tension side of the fracture. These fractures are often comminuted and commonly occur in elderly patients with poor bone density. The objective of this review is to examine the research studies that compare the biomechanical performance of locked and nonlocked plates for the specific application of difficult diaphyseal or metaphyseal osteoporotic fractures.