The locking reconstruction plate 2.4 is a very heavy and thick plate used to provide maximal stability. This plate is difficult to bend due to its stiffness. Large and complex bending is done most efficiently by using a template.
Several plate configurations are available with corresponding templates to satisfy all clinical situations.
If the plate will span the angle, preferably use prebent plates in order to avoid extreme in-plate bending. Metal fatigue with plate fracture can result from excessive and/or repetitive plate bending.
The templates are very malleable and easy to configure. Note there are no screw holes fabricated in the templates to prevent implanting these devices.
Basically, the same mode of bending and trimming applies to heavy locking plates 2.0, ie, the large and extra-large profile variety.
AO Teaching Video on bending of a reconstruction plate
|Contouring of the template|
First, adapt the template to the desired contour.
The template is used as a reference throughout the entire bending process.
|Trimming the plate|
The template is used to determine the length of the plate, specifically the number of holes necessary. The reconstruction plate is cut to the desired length using the “shortcut” cutting device.
Insert the reconstruction plate into the instrument where the desired cut is planned.
Place the opposite instrument immediately adjacent to the desired cut. Both instruments are gently squeezed together to cut the plate.
The instruments are separated and the desired cut is seen.
|Filling plate holes with screws|
Fill the threaded plate holes with bending insets. Insert them into those holes which will later be filled with locking screws.
Without these bending insets the holes become deformed and the precise seating of the locking screws can no longer be guaranteed.
The use of the prebent plates can provide better screw seating as the major bends are already completed and less manipulation is required by the surgeon.
|Plate bending: general considerations|
There are three types of bends necessary to adapt a plate.
- In-plane bending
- Out-of-plane bending
|Plate bending: in-plane bending|
With the bending pliers, the plate can be bent in two planes.
In the first step, bend the plate in plane.
The appropriate slot is marked on the bending pliers. Guide the plate in gradually through the opening of the pliers, according to the curvature required.
For contouring in the opposite direction, the plate must be turned 180°.
Check against template
Check the curvature of the plate against the template repeatedly during the in-plane bending of the plate.
When the process is finished, the curvature is checked again against the template.
|Plate bending: out-of-plane bending|
In the second step, the plate is bent out of plane. The plate is inserted into the opening which is marked correspondingly.
As an alternative, the plate can be bent out of plane using the nose of the pliers. This is suitable for extreme curvatures in particular.
The end portion of the plate can also be bent over a short distance.
|Plate Bending: bending irons|
Alternative bending technique
In-plane and out-of-plane plate bending can also be done with the bending irons. Bending irons have two different openings to allow plate bending.
For in-plane contouring the appropriate openings are used. The best way is to position the bending irons opposite each other.
Bending out-of-plane is carried out with the openings as shown.
|Plate bending: plate torquing|
The bending procedures are completed with the torquing of the plate. The plate is inserted into the vertical openings ...
... and the bending irons are rotated against each other.
|Check plate against template|
The template is used again to check if the plate is contoured correctly.
After bending is finished, remove the bending insets.