Patient Information Resources

Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

View Web RX

« Back

What can you tell me about locking versus non-locking metal plates for hand fractures? The surgeon who is treating my father (he has a broken hand) asked us which he might prefer but we left it up to the surgeon to decide because we don't know enough about it. What can you tell us?

Complex fractures of the long bones of the fingers (called metacarpal bones can be challenging to set in place and hold until healing takes place. The same is true for the phalanges (shorter bones of the fingers) with similar fracture patterns. Simple, nondisplaced fractures may do well with a finger splint, but displaced (separated) or comminuted fractures (many small bone fragments) usually require surgical stabilization. Metal implants may be used to hold the bones together during fracture healing. These plates are made of titanium, stainless steel, or a titanium alloy. The plates can be locking or non-locking. Locking plates provide more stability than non-locking plates. They are used most often with unstable, comminuted (severe) finger fractures. There is less pressure on the bone with the locking plates. This feature helps reduce injury to the nearby tendons and interferes less with microvascular circulation inside the bone. The locking plates have two other features not present in non-locking plates. One is the ability to use screws with different angles. The other is a far cortical locking mechanism on the other side of the fracture. This feature has not been studied in hand fractures yet. But other studies show far cortical locking stimulates bone growth by allowing a tiny bit of movement within the bone fragments. That movement signals bone to form the needed callus to stabilize the fracture. The major limitations of locked plating are the tendency to be too stiff to allow fracture healing. A little movement within the bone fragments actually helps with bone healing. Studies show locking plates have fairly high nonunion rates when used in other bones. Studies of limitations using the locking plates for metacarpal or phalangeal fractures of the hand have not been reported. The non-locking plates help reduce severely displaced bone fragments. There is less tendon irritation and less scar tissue formed when the non-locking plates are used. The surgeon can choose to put the screws in place in a double row using either a parallel or staggered pattern. It is also possible to choose different sized-screws for better fixation if that is required. There are some disadvantages to non-locking metal plates. For example, the screws have enough wiggle to them that they can start to loosen causing plate loosening and implant failure. The non-locking plates don't work as well with patients who have decreased bone density, bone loss, or comminuted fracture patterns. Simply stated, the non-locking plates may not provide enough fixation to create a stable fracture site. Leaving the decision up to the surgeon is a good plan. He or she will have the best idea what will work well for your father once the procedure gets started. Size and number of bone fragments present, strength (or fragility) of bone, and circulation will all be considered when making the final choice.


« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.