[The biological plate osteosynthesis].

The continually evolving understanding of bone biology and the analysis of clinical complications have led to a modified approach in internal fixation using plates. Anatomical reduction of the fragments in comminuted diaphyseal and metaphyseal fractures itself is no longer a goal. Important reduction aims are the correct length of the bone, and axial and torsional alignment. The preservation of the viability of the bone fragments is the key to unimpaired fracture healing. The primary stability of an osteosynthesis seems to be of minor importance for bone healing. More important is the rapid integration of unreduced but vital fragments into the fracture callus which buttresses the fracture area opposite the plate reducing the risk for overload and fatigue failure of the implant. Additional primary bone grafting leeds to local vascular disturbance of the bone and is rarely indicated. Indirect reduction technique with the aid of the fracture table or the distractor and a minimal but optimal use of implant material is the new concept to achieve undisturbed fracture repair in metaphyseal and diaphyseal fractures. In articular fractures the anatomic restoration of the articular surface can be obtained by the combination of indirect reduction technique (ligamentotaxis, soft tissue taxis) and accurate direct reduction of certain strategic fragments. Modifications of the plate design (limited contact, point contact) which minimize additional vascular damage to the bone help to accomplish this new concept.