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Dorsal bridge plating for distal radius factures

Contributors:Katherine Faust and Jacob Brubacher

Internal distraction, or bridge plating, of distal radius fractures is a valuable tool for highly comminuted and unstable fracture patterns. Additionally, this technique is valuable for those fractures that extend into the metadiaphysis or for multiply injured patients requiring stable fixation for mobilization. Bridge plating allows for stable fixation in poor bone quality and early use of the injured extremity.

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Multiple plates have been used for the bridge technique and include both titanium and stainless steel and most commonly range in size from 2.4 mm to 3.5 mm. This video demonstrates the use of the Wrist Spanning Plate from Acumed. The patient is positioned supine and a hand-table is used.
Standard trauma work-up and medical clearance is mandatory. Radiographs of the wrist and forearm are used to define injury pattern and assess for more proximal pathology.
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Digital motion can be initiated immediately post-operatively. Platform weight- bearing is allowed to assist in mobilizing the multiply injured patient. We routinely remove the plates 12 weeks after placement. Furthermore, bridge plating maximizes the biomechanical principles of external fixation by minimizing the bone-to-bar distance. The favorable biomechanics of this technique has largely supplanted the use of external fixation in our practice.
This technique provides decreased complication rates compared to external fixation. Risk of digital stiffness can be minimized by assuring there is not excessive distraction and full passive digital flexion and extension can be achieved after plate placement. Tenolysis may be peformed at time of plate removal.
Dr. Richard is a consultant for Acumed.
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1) Hanel, D. P., Ruhlman, S. D., Katolik, L. I., & Allan, C. H. (2010). Complications associated with distraction plate fixation of wrist fractures. Hand Clinics , 26 (2), 237 �¢ï¿½ï¿½ 243. http://doi.org/10.1016/j.hcl.2010.01.001 2) McQueen, M. M., Michie, M., & Court-Brown, C. M. (1992). Hand and wrist function after external fixation of unstable distal radial fractures. Clinical Orthopaedics and Related Research , (285), 200 �¢ï¿½ï¿½ 204. 3) Papadonikolakis, A., & Ruch, D. S. (2005). Internal distraction plating of dista l radius fractures. Techniques in Hand & Upper Extremity Surgery , 9 (1), 2 �¢ï¿½ï¿½ 6. 4) Richard, M. J., Katolik, L. I., Hanel, D. P., Wartinbee, D. A., & Ruch, D. S. (2012). Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. The Journal of Hand Surgery , 37 (5), 948 �¢ï¿½ï¿½ 956. http://doi.org/10.1016/j.jhsa.2012.02.034 5) Ruch, D. S., Ginn, T. A., Yang, C. C., Smith, B. P., Rushing, J., & Hanel, D. P. (2005). Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. The Journal of Bone and Joint Surgery. American Volume , 87 (5), 945 �¢ï¿½ï¿½ 954. http://doi.org/10.2106/JBJS.D.02164 6) Szabo, R. M., & Weber, S. C. (1988). Comminuted intraarticular fractures of the distal radius. Clinical Orthopaedics and Related Research , (230), 39 �¢ï¿½ï¿½ 48. Chhabra, A., Hale, J. E., Milbrandt, T. A., Carmines, D. V., Degnan, G. G. (2001) Biomechanical efficacy of an internal fixator for treatment of distal radius fractures. Clinical Orthopaedics and Related Research, (393), 318-215.

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