Dorsal bridge plate fixation

Dorsal bridge plate fixation is an open reduction internal fixation technique for extensive comminuted articular and metaphyseal radial fractures.

Terminology

Dorsal bridge plate fixation is also known as dorsal spanning plate fixation.

Indications

The main indication is the treatment of difficult distal radius fractures such as ^1,2:

• extensive comminuted articular and metadiaphyseal fractures in high-energy injuries
• insufficient distal bone stock or poor bone quality
• distal fracture lines
• associated wrist instability
• polytrauma with the need for immediate upper extremity weight-bearing

Contraindications

A relative contraindication of dorsal bridge plate fixation is a volar shear fracture which does not reduce with longitudinal traction ¹.

Procedure

The dorsal bridge plate fixation technique comprises the following ^1,2:

• wrist traction achieved through finger traps
• placing the dorsal spanning plate on the second or third metacarpal and radial diaphysis
• screw fixation

Complications

Complications of dorsal bridge plating include the following ¹:

• radial sensory nerve branch injury or neuritis
• extensor pollicis brevis and abductor pollicis longus tendon irritation
• carpal tunnel syndrome
• plate fracture

Radiographic features

Plate position and fracture healing can be assessed with wrist posteroanterior and lateral views.

Radiological report

The radiological report should include the description of the following features ¹:

• loosening
• callus formation
• displacement

Outcomes

The dorsal bridging plate can be typically removed upon radiographic evidence of fracture healing, commonly 2 to 3 months after the placement.

Advantages of this approach include the following:

• preservation of the volar soft tissue
• potential avoidance of pin migration or pin-site infection
• early light functional use and digital motion

Disadvantages include a shortcoming in the control of articular fragments and an additional surgical procedure for plate removal.