In cases of unstable fractures—such as those resulting from trauma or in patients with osteoporotic bones—surgical treatment using plate osteosynthesis is often performed. In this procedure, screws and metal plates stabilize the fracture until natural bone healing is complete. This surgical treatment method is used particularly for unstable or osteoporotic fractures to stabilize the bone and promote fracture healing. In rare cases, mechanical stress or bone resorption can lead to complications with the implanted plate. Under certain circumstances, a false joint (pseudarthrosis) may also develop. This is usually accompanied by a fracture of the implanted plate. Initially, this manifests as mild pain, which is followed after some time by sudden, severe pain. Malalignment in the area of the fracture is also possible.
Here you will find further information as well as a selection of plate fracture specialists and centers.
Definition and Causes of Plate Fractures in Fractures
In a small number of cases, pseudarthrosis develops following surgical treatment. This is usually accompanied by a plate fracture of the implanted plate. Such a fracture of the osteosynthesis plate is a typical complication following fracture treatment. It occurs particularly frequently in pathological or osteoporotic fractures, when bone quality is reduced or weight-bearing occurs too soon.
A plate fracture occurs when the fracture does not heal. This means that, after a certain period of time, the bone fails to take over the plate’s function.
Every plate is subject to constant bending stress in both directions as long as the bone has not yet healed. It is similar to bending a piece of floral wire back and forth. Over time, this also leads to a fracture of the plate.
Under normal conditions, it is impossible for doctors to implant a defective plate. The typical scenario is that the fracture does not heal in a timely manner.
Symptoms and Diagnosis of an Inguinal Hernia
After a period of mild pain, severe pain suddenly occurs in the area of the hernia. Patients often report a sudden increase in pain as well as restricted movement. Misalignment of the affected bone or a feeling of instability may also indicate a recurrent hernia.
Sometimes a misalignment is also visible in the area of the fracture. In some cases, the plate may even protrude through the skin. This indicates not only a plate fracture and the formation of a pseudoarthrosis, but also an infection of the fracture site.
A plate fracture or implant fracture is usually diagnosed after an X-ray is taken. For an accurate diagnosis, additional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are used to better assess the fracture location and potential complications.
Fractures of individual screws occur much more frequently than fractures of the entire plate. A fracture of an individual screw often leads to only a slight worsening of symptoms and typically heals spontaneously.
Ankle fixation using plates and screws in an X-ray image © Fotokon | AdobeStock
Treatment of a Plate Fracture
Treatment of a fractured plate usually involves removing the plate. Depending on the type of fracture and bone quality, a second surgical procedure is then performed. This involves either reduction and re-stabilization of the fracture using a new plate or—in the case of certain bones, such as long bones—treatment with an intramedullary nail.
In complex cases, angle-stable systems or cancellous screws are also used to ensure stable bone healing.
In addition, bone grafting is often necessary.
Either from:
- artificial bone or
- bone from the iliac crest
If there is a secondary infection, a multi-stage procedure—i.e., debridement first, followed by stabilization—may also be necessary.
Follow-up Care for a Plate Fracture
Follow-up care consists of mobilization and weight-bearing within pain-free limits. Postoperative follow-up is conducted at regular intervals using X-rays to monitor the healing process. During the conservative treatment phase, the focus is on physical therapy and muscle strengthening to prevent misalignments and restricted movement.
The standard approach is either:
- Full weight-bearing or
- 15 kg partial weight-bearing after discharge
After 4 to 6 weeks, the patient can usually transition to full weight-bearing.
Removal of metal implants is often necessary for surgically treated ankle fractures. Otherwise, the plates and screws would cause discomfort under the relatively thin layer of skin and fatty tissue at the ankle.
If there are no local symptoms, removal of the metal hardware is not necessary.
A return to sports is typically possible after 3 to 6 months.
Prognosis for Healing After a Plate Fracture
Factors influencing the prognosis for healing after a plate fracture include:
- Type of primary fracture
- whether the fracture heals well
- whether the fracture heals by bridging over time
The prognosis is also compromised by additional medical conditions such as diabetes mellitus. Osteoporotic or unstable fractures also heal more slowly, especially when bone mass is reduced. Careful follow-up care and, if necessary, a bone density test help minimize the risk of further complications.
Smoking also worsens the chances of healing, especially after a plate fracture.
FAQ
What is a plate fracture and how does it occur?
A plate fracture refers to the fracture of an implanted metal plate following surgical bone repair (plate osteosynthesis). It usually occurs when the original bone fracture has not healed completely. Constant stress can eventually cause the plate to split—similar to a wire that is constantly bent back and forth.
What symptoms indicate a plate fracture?
Initially, mild pain that suddenly becomes severe is typical. Swelling, limited range of motion, or misalignment in the area of the fracture also frequently occur. In severe cases, the plate may even become visible under the skin. An X-ray confirms the diagnosis.
How is a plate fracture treated?
Treatment is usually surgical. During the procedure, the damaged plate is removed, the fracture site is cleaned, and the area is then stabilized again—either with a new plate or an intramedullary nail. In some cases, a bone graft is also necessary to support healing.
What is the prognosis for healing after a plate fracture?
The prognosis is usually good, but it depends on various factors—such as the type of original fracture, comorbidities like diabetes, or smoking habits. After surgery, patients can usually resume full weight-bearing after 4–6 weeks, and athletic activities are possible after about 3–6 months.
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