A Precursor of the Locking Plate System: Noncontact Plate Osteosynthesis by Zespol, Construction, Technique, and Tactic

A review of the literature in 2002, analyzing 13 articles with 895 tibial shaft fractures treated by cast immobilization, fixation with plate and screws, and reamed or unreamed intramedullary nailing, concludes that the combined incidence of delayed union and nonunion was lower with operative, surgical treatment especially with plate osteosynthesis, than with closed treatment. This incidence was respectively 2.6% with plate fixation, 8.0% with reamed nailing, and 16.7% with unreamed nailing compared with 17.2% with closed treatment. On the contrary, the incidence of superficial infection was most common with plate infection—9.0%, compared with 2.9% for reamed nailing, 0.5% for unreamed nailing, and 0% for closed treatment. The incidence of osteomyelitis was similar for all groups. Rates of reoperations ranged from 4.7% to 23.1%. The dynamic compression plate (DCP) has been used for many years as a method of internal fixation of fractures. A problem that has created concern after plate fixation is the appearance of porous bone under the plate during the course of healing. This has been attributed to disruption of the blood supply near and beneath the plate. In an attempt to address this problem, plate designs that make only limited contact (LC-DCP), point contact (PC-Fix internal fixator), or noncontact plates (NCP) with the underlying bone surface have been designed.