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Locking Plates: Concepts and Applications

Anand J. Thakur. pp. 432. LWW, 2013. EAN : 9788184738711 

Locking plates are popular implants in fracture management offering mechanical and biological advantages, especially for the osteoporotic fractures that are increasingly common.

This book is divided into 2 sections: the first covers basic science and principles of bone healing and plate osteosynthesis; the second covers region-specific applications of locking plates.

The basic concepts discussed are suitable both for residents preparing for fellowship examinations and for practicing orthopaedic surgeons using the devices regularly or considering the financial implications of switching from conventional to locking plates.

Practical topics, including indications for locking plates, plate length and screw density, are discussed in depth. The chapters are comprehensive and include important discussions on complications and implant removal.

The second section comprehensively covers all regions from clavicle to calcaneum. There is a useful chapter on paediatric applications of locking plates. The chapters are written in a practical format, from indications to surgical techniques, which are discussed step by step, accompanied by illustrations and boxes that contain quick references. There is an extensive literature review with a detailed reference list after each chapter. However, while the author has quoted a number of operative techniques described in the literature, he does not mention their ease of application or usefulness, requiring the readers to be cautious in applying the steps. For example, in the section on proximal humerus fractures, the plate-joystick technique, using two Kirschner wires for reduction of a varus humeral head, is quoted, but it is not mentioned that this technique is often difficult to control, especially in osteoporotic bone.

Certain chapters in this book deserve particular mention. The chapter on minimally invasive plate osteosynthesis is elegant, with detailed descriptions of methods of direct and indirect reduction of fractures with different tools, but the simpler method of percutaneous application of bone clips is not mentioned, though in most instances it can produce perfect reduction. The chapter dealing with distal radius fracture is excellent in depicting steps of volar locking plate fixation; however it has no mention of the dorsal horizon view X-ray, which allows intraoperative detection of dorsal penetration of locking screws. This complication can cause extensor tendon rupture, and is difficult to detect even with careful fluoroscopic screening.

The strength of this book is in the comprehensive discussion on all aspects of locking plates from concepts to applications in all body regions. I particularly enjoyed the abundant illustrations, which appear on almost every page. My only slight disappointment is that all the images are monochrome - more colour images will enrich the book.

In summary, Dr Thakur has produced a comprehensive text on all aspects of locking plates. It provides good materials for all surgeons who are taking care of patients with fractures.

Reviewed by Dr Dennis Yee