Polyaxial vs. Monoaxial Angular Stability in Osteosynthesis with Internal Fixators for Complex Periarticular Fractures

Plates with angular stability (monoaxial or polyaxial) are competing for indications in periarticular fractures of the long bones, consisting, according to most authors, the ideal treatment at present time. However, the best option for screw locking is controversial and insufficient investigated. The authors present their personal experience regarding angular stability plate osteosynthesis for the fractures of the proximal humerus, distal radius, distal femur, proximal tibia. Results for the treatment with internal fixator plates are much better than the results for classic implants osteosynthesis (mainly in fractures on osteoporotic bones), accounting for construct stability, lack of secondary displacements, early rehabilitation. Polyaxial locked plates has the advantage of screw pathway adjustment (their positioning being adapted to a specific fracture). The large case distribution in different hospital services and good results following this treatment lead to the conclusion that locked plates represent the unique issue in complex periarticular fractures and in osteoporotic fractures. Close cooperation between orthopaedic surgeon, biomechanics and robotics specialist, and the departments of cell biology and pathology will contribute to the creation of the ideal internal fixator.