Last Updated on February 11, 2025
Bone plates are the implants used in the internal fixation of fractures. The plate is fixed to the bone by application of screws on both sides of the fracture. Plating is widely used for the fixation of diaphyseal fractures of the upper extremity and metaphyseal and articular fractures.
Plates for fixation of long bone fractures were first recorded by Hansmann, of Heidelberg University, Germany in 1886.
Plates are now widely accepted with different standard techniques of osteosynthesis, throughout the skeleton. Different anatomical locations demand different shapes and sizes of plates.
For a plate to be an effective means of fixation it should meet the following requirements
- It should be of appropriate width and thickness for the given bone
- The plate must have an adequate and symmetric hold on either side of the fracture
- The plate must be closely opposed to the contour of the bone.
- The plate must neutralize all forces acting on the fracture i.e bending, compression, shear, and torque
Bone plates come in different sizes and shapes depending on the size of the bone and its anatomical shape. Different sizes of plates require different sizes of screws.
Most of the bone plates are made of stainless steel or titanium.
Indications for Use of Bone Plates
The use of plate is indicated:
- When anatomical alignment must be restored accurately
- Where the use of screws alone is inadequate
- When load sharing may be achieved with confidence. If this cannot be guaranteed, then a bone graft may be added at the site of any deficit.
The areas of the body where the conditions described above arise commonly are:
- Around joints – failure to restore a joint surface to its normal shape may lead to osteoarthritis because of uneven wear of the joint surfaces.
- In the bone of the forearm, which rotates about each other.
- On the pelvis especially around the acetabulum
- On the face and jaw
Tension Band Principle of Plating
Bones are not always loaded evenly along their axes – if they are not this is called eccentric loading. This also can occur in a fracture if the soft tissues are stripped off one side while remaining intact on the other. These factors produce a tendency for a loaded bone to distort more or one side than the other.
If a plate is fixed on the side tends to open – the tension side – then this will counteract the eccentric load, compressing the fragments together at the side under the plate. The eccentric load will continue to compress the bone fragments together on the side of the bone opposite to the plate. In this situation, the fracture is compressed throughout the bone cross-section and the plate suffers an equal and opposite force – tension.

Image Credit: AO Foundation
The following criteria must be fulfilled for a plate to act as a tension band:
- The fractured bone must be eccentrically loaded.
- The plate must be placed on the tension side.
- The plate must be able to withstand the tensile forces.
- The bone must be able to withstand the compressive force which results from the conversion of distraction forces by the plate.
- There must be a bony buttress opposite to the plate to prevent cyclic bending.
The plate is acting as a tension device or band. The plate is placed opposite the tension side of the bone and will easily be deformed by the opening of the fracture when eccentric loading is applied.
[Read details of Tension band Principle]
Types of Modes of Bone Plating
Wherever possible plates should be put on the tension side of a fracture. This is not always possible for anatomical reasons, such as the need to respect the blood supply of the bony fragments or the risk of tethering mobile structures such as tendons.
Depending upon the fracture location and type, a plate can be used in any one of the following modes
Compression Mode
The word compression in fracture fixation means bringing the two fragments closer to each other so that the fragments oppose well. The following x-ray shows the use of a plate in compression mode.

When the plate is used to achieve compression in addition to fixation of a fracture, it is said to be used in compression mode. This mode is used on transverse and oblique fractures
Neutralization Mode
In this type of plating, a lag screw is used to neutralize bending, shear, and rotational forces. The aim of this type of plating is not to achieve compression [This has already been achieved by the lag screw.]
This kind of plating is also used as an adjunct where screws are used alone in long bones an accurate reconstruction with interfragmentary compression can be achieved, but screws are not particularly strong in resisting bending or twisting forces. The addition of a plate provides further resistance to such forces.
In the following x-ray, the fracture has been compressed with a lag screw but the plate is needed to neutralize other forces.
The fibular fracture commonly seen in ankle injuries is often fixed with lag screws protected by a neutralization plate.
The plate is put on the tensile surface of the bone but it is not prebent. [see below for prebending]
Buttress plate
A buttress is an architectural structure built against or projecting from a wall that serves to support or reinforce the wall. A buttress plate is used to prevent a collapse in fracture patterns that are unstable under compressive forces.
A buttress plate is very thin as compared to a compression plate and is mostly applied on the compressive surface of the bone.
This is the most common way that plates are used around joints. Here is an example of a buttress plate used for lateral condyle tibia fracture

Here there is a relatively soft cancellous bone core surrounded by a thin layer of together cortical bone. Accurate osteosynthesis may be achieved by lag screws alone but under load, there may be a risk of the screws cutting out of the bone or bending.
The addition of a plate will prevent such deformity under axial load. The plate should be situated where the maximum load is predicted to be. Proximal tibia, for example, plates may be required on one side or another to protect a tibial plateau fracture fixation.
There are specially shaped plates for the most common anatomical buttressing requirements, and this makes the application of the plate easier.
Antiglide Plate
In antiglide plating, the plate is fixed to the bone in such a way that it prevents the distal fragment from overriding when force is applied along the long axis of the bone. ‘
The distal fragment is firmly wedged between the plate and the fracture surface of the proximal plane.

This principle is mostly applied in the fracture of the distal fibula as in the above diagram. It can be called a variation of compression plating.
Span Plating or Bridge Plating
It is a modification of neutralization mode which is applied when there is comminution and one does not want to dissect the fracture area to avoid devitalization of the fragments.
This kind of plating is done under X-ray control or a C-arm image intensifier. The plate is contoured slightly to bypass the fracture zone and fixed only to major proximal and distal segments.
This not only minimizes the devitalization of the fracture zone but also promotes the formation of periosteal callus.
In this method of plating, the farthermost screws in the plate are applied on either side and then fixation moves towards the center on either side of a fracture zone with holes of plate spanning left unused for fixation.
In the above x-ray, the plate in the tibia is used in bridging mode.
Tension Band
A plate can also be solely used as a tension band apparatus.
The plate is attached to the tension side of a fracture and converts the tensile force into a compressive force at the cortex opposite the implant. An example of such use is in olecranon fracture’
Prebending or Overbending of Bone Plates
In compression mode, apart from the fixation of fractures, the application of the bone plates aims for closer apposition of the fracture fragments.
Long bones are like hollow metallic cylindrical pipes in the diaphysis. The side where the screw makes its first entry is called near cortex [As it is nearer to you]. The opposite side where the screw exits is called the far cortex.
Prebending means bending a straight bone plate before application to the bone. The bend is such that the midsection of the plate is elevated from the bone surface prior to fixation to the bone.
If the plate is applied as such it produces asymmetric compression because the near cortex is compressed more than the far cortex, or the far cortex may not be compressed at all;
When the prebent plate is fixed to the bone, due to its elastic recoil, the plate has a tendency to recover the bend. This exerts a bending moment at the fracture site which results in the closure of the far fracture gap.
Thus overbending bending aims at balancing forces on the near and far cortices as far cortex compression produces stability enough to maintain contact under physiologic loading.
A distance between the two innermost screws is the most active portion of bending and therefore a sharp bend is preferable to a smooth curve. The aim should be to elevate the bend about 1-2 mm from the bone surface.
A smaller bend would be ineffective in achieving proper far cortex compression. To fix the prebent plate to the bone, inner screws should be applied first and the outer last;
Sometimes a straight plate is applied to the curved bone. [Relative pretending] In such a scenario, outer screw holes are inserted first. As the plate conforms to the bone, it has the effect of shortening the plate resulting in compression across the fracture site.
Here is what AO says on the Overbending of bone plates. The above image is a curtsy of the same-
The solution to this problem is to “overbend” the plate so that its center stands off 1–2 mm from the anatomically reduced fracture surface. The overbend should lie directly over the fracture line. When the first screw is inserted, slight gapping of the cortex will occur directly underneath the plate. After fixation is complete, the plate will be in contact with the bone throughout its length but will act as a spring, providing compression at the far cortex.
Different Types of Orthopedic Bone Plates
Dynamic Compression Plate
In the first designs of the bone plate, the screw holes were round but with a dynamic compression plate or DCP, there was an improvement in the design. This plate has specially shaped screw holes which have an inclined plane at one end.
When the screw is placed at this end of the hole and driven home, it slides down this plane, pulling the plate and causing compression of the bone fragments.
If the screw is placed in the center of such a screw hole in a plate it does not make contact with the inclined plane and movement of the plate relative to the inserted screw does not occur – in this situation, the screw is said to be placed in a neutral position.
Each screw hole in a plate is situated in a recess which is shaped to accommodate the rounded undersurface of the screw head. This has three benefits:
- By burying the screw head in the plate the whole construct has a smoother profile which does not irritate soft tissues.
- The contact between the plate and screw heads is optimized to prevent stress raisers.
- The screw may be slightly angled relative to the plate which may help in achieving optimal screw placement in the bone.
DCP is of the following types
- Broad DCP -uses 4.5 mm screws, used in the femur and tibia
- Narrow DCP- uses 4.5 mm screws, used in the humerus
- Small DCP, uses 3.5 mm screws, used in radius, ulna, fibula
- Miniplates, use 2.7/2.0 mm screws for metacarpals/phalanges
Limited Contact Dynamic Compression plates
Experimental work proved that the under-surface of the DCP, by contact with bone interfered with the blood supply of the underlying cortex.
The area of the undersurface of the plate in contact with bone is called the footprint of the plate.
Limited contact dynamic compression plate or LCDCP was an attempt to reduce the footprint of the bone.
The LCDCP has a fluted undersurface and minimizes the plate bone contact.
LCDCP also comes in the same sizes as DCP.
Locking Compression Plates
A locking compression plate is called so because it has got screws with threaded heads which lock themselves when inserted into threaded plate holes, thus locking the screw with the plate.
The plate also has conventional holes and can be used as a conventional plate system.
From the middle of the plate, the distal hole is simple and the proximal hole of the combi hole is threaded.
The threaded or locking hole adjoins the conventional hole and the arrangement is called a combi hole. The locking compression plate has a combi hole that permits the insertion of standard head screws and threaded locking head screws.

The LCP is also designed with a minimal footprint [the surface area that is in contact with bone].
Locking plate application provides locked plate/screw constructs compared to non-locked plate/screw constructs which are stronger, especially to angular forces. It is an especially useful feature in comminuted metaphyseal fractures.
The locking plate is used in the following situations
- In indirect fracture reduction
- Fractures of osteoporotic bone
- For bridging in severely comminuted fractures
- Short segment fixation
- Percutaneous fixation of fractures
The advantages of locked fixation are
- Sparing of periosteal blood supply
- Lack of need for contouring
- Improved holding power
Reconstruction Bone Plates
These plates have notched edges to permit bending in any desired plane. These plates are very adaptable and are useful in complex anatomical sites, such as the distal humerus, the pelvis, the clavicle. An application of the reconstruction plate is shown in the beginning of the article.
Anatomical plates/angular Locked Plates

The plate given in the above diagram is an anatomical plate for distal tibial fractures. These are specially contoured plates for different anatomical sites. For example distal humerus plate, distal tibial plate or proximal tibial plate.
These plates are typically used for intra or juxtarticular fractures because the bone anatomy is unique near the joints.
Bone Plates Fatigue and Failure
Bone Plates are load-bearing devices. That means when it is used to fix the fracture, it bears the load transmission. This is, in contrast, to load-sharing devices like interlock nails which share the load with bone and do not completely bear it.
In cases where the fracture is well reduced and not comminuted, the transfer of load can be shared by the plated bone as it acts as a unit.
But if there is a defect or gap at the fracture site the plate will be prone to bending. This usually happens because the fractured bone is not accurately re-assembled. In some cases of limb loading, the plate may bend backward and forward as the incomplete bone-plate construct is loaded. This backward and forward cyclical movement is likely to result in early fatigue failure of the plate.

In order to minimize this problem a number of factors should be considered when designing a plate:
- The system of fixation with plates and screws should, together with the bone, form as stable a construct as possible.
- As little damage as possible should be done to the blood supply to the bone so that healing of the fracture complex takes place as quickly as possible.
- The plate should be placed relative to the broken bone so that it is minimally stressed.
- The plate should be placed relative to the soft tissues so that uninjured tissues are not unduly damaged. Ensuring as little damage as possible to the remaining blood supply to the bone.
- The plate should be made of materials that are as strong as possible and that can tolerate the fatigue effects of stress reversals.
References