Tips for Optimal Screw Placement in Variable Angle Locking Plates

 

Variable angle locking plates (VALPs) offer surgeons critical freedom when managing complex and periarticular fractures, but success depends heavily on precise screw placement. With the ability to lock screws 15–30 degrees off-axis, VALPs help avoid joints, capture strong bone, and improve fixation in comminuted or osteoporotic areas. Effective use starts with solid pre-operative planning using high-quality imaging, ideally CT scans, to map fracture lines and safe screw trajectories. Intraoperatively, using the dedicated drill guide and staying within the angular cone is essential to maintain locking strength. Smart selection of unicortical versus bicortical screws—especially near joints—reduces cartilage and tendon injury while maintaining stability. Loading screws in a controlled sequence prevents loss of reduction, and careful handling of poor bone quality with raft screws or augmentation improves outcomes. Final fluoroscopic checks and construct stress testing ensure stability. When executed correctly, VALPs reduce complications, support early motion, and turn challenging fractures into predictable successes.