A hospital procurement list for trauma fixation reads like an inventory of unrelated hardware: reconstruction plates, locking plates, cortical screws, cannulated screws, pegs, nails. In practice the whole catalog organizes around a few mechanical jobs, and once those jobs are clear, every implant on the list falls into place. This guide sorts orthopedic plates and screws by what they actually do — the way a surgeon reasons at the table — so that surgical teams and purchasing staff can specify systems with confidence. Implant selection for any individual fracture remains the decision of the operating surgeon.
Plates are classified by mechanical function, not by name
The same physical plate can serve different functions in different fractures, which is why implant names confuse newcomers. A plate is defined at the table by the job it performs: compression, buttressing, neutralization, bridging or antiglide. The five functions cover essentially all of plate osteosynthesis.
| Plate function | What it does | Typical use |
|---|---|---|
| Compression | Presses the fracture fragments together for direct healing | Simple transverse shaft fractures in good bone |
| Buttress | Shores up a metaphyseal fragment against axial load | Tibial plateau, distal radius, pilon fractures |
| Neutralization | Protects a lag-screwed fracture from bending and rotation | Oblique shaft fractures after lag screw fixation |
| Bridge | Spans a comminuted zone without touching it, healing by callus | Comminuted shaft and metaphyseal fractures |
| Antiglide | Buttresses a fracture spike so the plate itself compresses the fracture | Oblique distal fibula fractures |
Conventional and locking plates
Across all five functions, plates divide into two mechanical generations. Conventional plates work by friction: screws press the plate against the bone, and the friction interface carries the load. Locking plates work as fixed-angle scaffolds: screw heads thread into the plate, and the construct holds without friction, independent of bone quality. Locking technology earns its cost in osteoporotic bone, periarticular fractures and periprosthetic cases; conventional plating remains the efficient tool for simple shaft fractures in good bone. Most modern periarticular plates accept both screw types, used in sequence — conventional screws to seat and compress, locking screws to hold the angle.
Plates by anatomic region
Modern plating is anatomic: plates arrive pre-contoured to a specific bone region, with screw trajectories engineered for the local fracture patterns. A trauma formulary is therefore organized by region, and each region has its own plate families. The lower limb centers on the tibia and fibula — proximal plateau plates, distal tibia and pilon plates, fibular plates — and the hip and femur, from proximal femoral nails to distal femur locking plates. The foot and ankle runs from fibular and calcaneal plates to midfoot fusion plates in the foot and ankle collection. The upper limb covers the wrist and hand with volar radius and small-bone plates, the elbow with distal humerus and proximal ulna plates, and the shoulder and humerus with proximal humerus locking systems.
Screw types: the other half of every construct
Screws differ in thread form, and the thread form declares the bone the screw is built for. Cortical screws carry a fine, shallow thread for dense cortical bone. Cancellous screws carry a deep, widely spaced thread that bites into soft metaphyseal bone. Locking screws add a threaded head that engages the plate and can be either unicortical or bicortical. Cannulated screws run over a guide wire for precise placement in the femoral neck and small bones. Smooth pegs support articular surfaces in fixed-angle constructs where removal ease matters. Headless compression screws bury entirely in bone for intra-articular fragments. The complete inventory sits in the screws and fixation collection.
Sizes, materials and the 3.5 / 4.5 convention
Trauma plating is sized by the screw diameter the plate accepts, and two sizes dominate: the 3.5 system for small bones — radius, ulna, fibula, hand and foot — and the 4.5 system for large bones — femur, tibia and humerus. Smaller 2.7 and 2.4 systems serve the hand and distal radius margins. Material adds a second axis: stainless steel systems lead where contourability and cost matter, titanium systems where fatigue performance, imaging and anatomic pre-contouring matter — a comparison covered in detail elsewhere on this blog. Procurement teams normally stock both size families per region and let material follow the product line design. The convention simplifies everything downstream: instrument trays, drill bits and depth gauges are organized by the same screw diameter, so a scrub team can run an ankle case and a femur case off two familiar trays.
Where intramedullary nails fit
Nails are the third implant family, and they replace the plate rather than complement it. A nail sits inside the medullary canal and carries load down the center of the bone, which makes it the mechanically superior choice for most femoral and tibial shaft fractures and for trochanteric hip fractures. Cephalomedullary nails such as our long cephalomedullary nail add a head element into the femoral head for the trochanteric region; standard antegrade nails handle the shaft. The plate-versus-nail decision is region-driven: shaft fractures of the femur and tibia default to nails, metaphyseal and periarticular fractures default to plates.
How systems are specified in practice
Plates and screws are not picked individually from a catalog; they are specified as families that work together. A periarticular locking system pairs its anatomic plates with matched locking screws, conventional cortical screws for the compression step, drill guides and depth gauges calibrated to the plate geometry. When a hospital evaluates a system, the meaningful checklist runs: anatomic coverage of the region, screw diameter and length range, the availability of both locking and conventional options in the same plate, instrument quality, and — increasingly — the supply reliability of the distributor. Mixing screws across systems is technically possible but forfeits the engineered fit between screw head and plate hole.
Sourcing trauma fixation systems
BoneCraft is an independent distributor of genuine Zimmer Biomet trauma implants, stocking complete plating and nailing systems across all anatomic regions. Hospitals and distributors building or refreshing a trauma formulary can contact our team for availability, system documentation and lot records.
Frequently asked questions
What are the main types of orthopedic plates?
By mechanical function: compression, buttress, neutralization, bridge and antiglide plates. By implant family: plates that work on the bone surface, intramedullary nails that work inside the canal, and the screw types that serve both.
What is the difference between cortical and cancellous screws?
Thread form. Cortical screws have a fine shallow thread for dense cortical bone; cancellous screws have a deep widely spaced thread for soft metaphyseal bone. Using the wrong thread form in the wrong bone loses most of the screw's purchase.
When is a locking plate needed instead of a conventional plate?
In osteoporotic bone, periarticular fractures with small joint fragments, and periprosthetic fractures — anywhere friction-based fixation would fail. Simple shaft fractures in good bone remain conventional territory.
What does a buttress plate do?
It shores up a metaphyseal fragment against axial load so the fragment cannot shear off or collapse — the classic role in tibial plateau, distal radius and pilon fractures.
When are nails preferred over plates?
For femoral and tibial shaft fractures and for trochanteric hip fractures, where a load-sharing implant in the center of the bone outperforms a plate on its surface. Periarticular and metaphyseal fractures default to plates.
Can screws from one system be used with plates from another?
Thread diameters sometimes match, but locking head geometry is system-specific. Mixing forfeits the engineered fixed-angle fit, so plates and screws are specified and used as families.
What should a hospital check when specifying a plating system?
Anatomic coverage, screw size and length range, combined locking and conventional holes, instrument quality, and the distributor's stock reliability and lot documentation.
Zimmer Biomet, ZPLP, ALPS, DVR and ZNN are trademarks of their respective owner. BoneCraft is an independent distributor of genuine Zimmer Biomet products and is not affiliated with, sponsored by, or endorsed by the trademark owner.
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