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AMOS/OTA Techniques in Orthopaedic Trauma

AMOS/OTA Techniques in Orthopaedic Trauma. Mitchell Goldflies. Conventional Non-Locked Plating. Screw-Plate interface allows for toggle Stability depends on frictional force which is proportional to screw insertion torque

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AMOS/OTA Techniques in Orthopaedic Trauma

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  1. AMOS/OTA Techniques in Orthopaedic Trauma Mitchell Goldflies

  2. Conventional Non-Locked Plating • Screw-Plate interface allows for toggle • Stability depends on frictional force which is proportional to screw insertion torque • Instability results when patient load exceeds bone-plate frictional force • Screw failure is sequential

  3. Osteopenic Bone Model - Load to Failure • Compared to a 4.5 bicortical non-locking screw: • 4.0 locking unicortical screw – 17% greater • 4.0 locking bicortial screw – 82% greater • 5.0 locking bicortial screw – 92% greater • Not a great difference seen in normal bone • Unicortial locked screws poor in axial rotation

  4. Indications for locked plating • Osteroprosis • Small segments • Metaphyseal (Condylar) fractures

  5. Hybrid Fixation • Locking screws in metaphysis, nonlocking screws in diaphysis • Initial screws are not nonlocking and pull bone (fracture) to contoured plate for reduction, then addition of locking screws • Hybrid fixation similar to locked in stiffness

  6. Costs 4.5 DCP 8 hole 4.5 DCP Locking

  7. Cross Threading • 5% off axis – 43% reduction in bending strength • 10% off axis – 68% reduction in bending strength

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