Plate pre-contouring

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The ability to pre-contour a plate before surgery has several potential benefits including reduced surgical time, greater accuracy especially if complex contouring is necessary, and in some situations the ability to use the precontoured plate as a reduction guide. 

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This is commonly helpful during surgical management of comminuted long bone fractures, where achieving optimal relative alignment of the major proximal and distal segments of the fractured bone is essential. This can be particularly challenging in small patients, in humeral and especially femoral fractures, and when fractures are juxta-articular. Figure 1 shows a plate pre-contoured to a 3D-printed, mirrored, contralateral femur (the affected femur had a comminuted diaphyseal fracture). Appropriate alignment of the proximal and distal major fracture fragments resulted when the precontoured plate was applied in the same position.

In some non-comminuted fractures plate precontouring is helpful where complex plate contouring is necessary, especially if plate positioning is critical to adequately stabilise small fragments. Figure 2 shows plate pre-contouring prior to stabilisation of a feline humeral condylar Y-fracture.

Less commonly, a pre-contoured plate can act as a reduction guide in other situations such as open or closing wedge osteotomies for limb deformity, limb-spare surgery, and arthrodesis.

Figure 1 - Plate pre-contouring prior to stabilisation of a feline femoral fracture. A plate has been pre-contoured to a 3D-printed, mirrored, model of the contralateral femur (the affected femur had a comminuted diaphyseal fracture). Note the moderate torsion required to conform to the lateral aspect of the femoral condyle distally, a difficult feature to optimally judge intra-operatively. 

Figure 2 – Plate pre-contouring prior to stabilisation of a feline humeral condylar Y-fracture. The contralateral humerus has been 3D-printed, and the fracture lines marked (the fracture fragments were also printed) (A). Two plates have been pre-contoured with proximodistal positioning such that two screws can be placed into the lateral condylar fragment, and three medially (B and C).