Dorsal bridge plating for distal radius factures

Video Type: CVideo
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Author: Katherine Faust
Published:
Specialties: Orthopedic Surgery, Plastic Surgery
Schools: Duke University Hospital
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Basic Info

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.

Advanced

Procedure

Indications

Contraindications

Instrumentation

Setup

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.

Preoperative Workup

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.

Anatomy and Landmarks

Advantages/Disadvantages

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.

Complications/Risks

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.

Disclosure of Conflicts

Dr. Richard is a consultant for Acumed.

Acknowledgements

References

1)
Hanel, D. P., Ruhlman, S. D., Katolik, L. I., & Allan, C. H. (2010).
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2)
McQueen, M. M., Michie, M., & Court-Brown, C. M. (1992). Hand and wrist
function after external fixation of unstable distal radial fractures.
Clinical
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3)
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