The locking 2.4 reconstruction plate is a very thick plate used to provide maximal stability. This plate is difficult to bend due to its stiffness. Large and complex bending is done most efficiently by using a template.
Several plate configurations are available with corresponding templates to satisfy all clinical situations.
If the plate will span the angle, preferably use prebent plates to avoid extreme in-plane bending. Metal fatigue with plate fracture can result from excessive or repetitive plate bending or both.
The templates are very malleable and easy to configure. Note there are no screw holes fabricated in the templates to prevent implanting these devices.
In principle, the same bending and trimming method apply to heavy locking plates 2.0, ie, the large and extra-large profile variety.
The pre-bent plates can provide a better anatomical fit as the major bends are already completed. Furthermore, pre-bent plates require less manipulation and are therefore less likely to suffer from metal fatigue.
AO Teaching Video on bending of a reconstruction plate
First, adapt the template to the desired contour.
The template is used as a reference throughout the entire bending process.
The template is used to determine the plate length (the number of holes) necessary.
The reconstruction plate is cut to the desired length using the "shortcut" cutting device (cutting irons).
Insert the reconstruction plate into the instrument where the desired cut is planned (between two plate holes).
The smooth sides of the cutting irons face each other.
After engaging the cutting irons, confirm the intended site to prevent cutting the plate through the hole, which is a common mistake.
Place the opposite cutting iron immediately adjacent to the desired cut. Both instruments are gently squeezed together to cut the plate.
The instruments are separated, and the desired cut is seen.
When indicated, fill the threaded plate holes with bending insets. Insert them into those holes, which will later be filled with locking screws. Without these bending insets, the holes become deformed, and the precise seating of the locking screws can no longer be guaranteed.
There are three types of bends necessary to adapt a plate. These are performed in the following sequence:
The plate can be bent in-plane and out-of-plane using universal bending pliers.
In the first step, bend the plate in-plane.
The appropriate slot is marked on the bending pliers. Guide the plate in gradually through the opening of the pliers, according to the curvature required.
For bending in the opposite direction, the plate must be turned 180°.
Check the curvature of the plate against the template repeatedly during the in-plane bending of the plate.
Always start bending from either end of the plate while continuously verifying with the template, do not begin in the plate's center.
When the process is finished, the curvature is rechecked against the template.
The plate can be bent out of the plane using the pliers' nose. The pliers' nose is particularly suitable for extreme curvatures.
It is imperative to systematically start from one end of the plate and bend the plate segment by segment to perfectly replicate the template's contour.
Any other approach (eg, starting in the middle) will make it challenging to achieve the correct contour.
In-plane and out-of-plane plate bending can also be done with the bending irons. Bending irons have two different openings to allow plate bending.
For in-plane bending, the appropriate openings are used. The best way is to position the bending irons opposite each other.
Bending out-of-plane is carried out with the openings as shown.
The bending procedures are completed with the torquing of the plate. The plate is inserted into the vertical openings...
... and the bending irons are rotated against each other.
The template is used again to check if the plate is contoured correctly.
After bending is finished, remove the bending insets.