The advent of volar locking plates has seemed to solve some of these issues. Popularized in the early 2000s,...
Distal Radius Operative Fixation
Evolution of Distal Radius Operative Fixation
A dorsal bridge plate, as the name implies, is applied to the backside (dorsal) part of the radius, proximal to the fracture, and spans the fractured distal radius and wrist joint where it is then secured with screws to either the second or third metacarpal (hand bones of index and middle finger respectively). This thus “bridges” the fractured intra-articular surface of the distal radius.
Application of this plate involves 2-3 incisions. First, two incisions are made, both roughly 5-7cm length: one near the base of the 2nd metacarpal (distal incision) and a second on the dorsal aspect of the forearm in the region of the radial shaft (proximal incision). If significant displacement of the intra-articular fragments is present, an incision directly over the dorsal wrist can be used to assess and reduce/stabilize the articular surface with the use of pins, k-wire, or small metal plates/screws.
The plate is then inserted typical through the distal incision and slid up along the bone to the proximal incision site. The plate is secured to bone with screws. Postoperatively, patients can bear weight/load bear through the forearm and elbow immediately after surgery. This can allow patients to use crutches (platform crutches at first with transition to regular crutches around one month post operatively).
Lifting and carrying is typically restricted to approximately 10lbs until the fracture has healed to minimize stress on the fractured portions of the bone/joint surface. The plate and screws are removed usually no earlies than 12 weeks after injury. At the time of hardware extraction the screws are removed and the plate slid from the incision. A removable short arm splint is worn for 2-3wks after plate removal. Hand therapy at the point is directed at regaining strength and motion, specifically of the wrist.