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Locked and minimally invasive plating: a paradigm shift? Metadiaphyseal site-specific concerns and controversies.

Metadiaphyseal fractures of long bones are associated with considerable deforming forces, tenuous soft-tissue envelopes, and, often, severely compromised osseous integrity. Contemporary methods to fix complex metadiaphyseal fractures must achieve a balance between the biomechanical and biologic environments. The advent of precontoured locking plates inserted with evolving minimally invasive techniques may achieve both goals. Enthusiasm for their application demands continued scientific validation. Indications and outcomes must be carefully evaluated, and the benefits and limitations of this combination of implant design and surgical execution must be recognized.