External fixation is the preferred method of actor stabilisation of open long bone fractures in the setting of poly trauma. In damage limitation surgery, plating may be preferred to intramedullary stabilisation due to a lower inflammatory response. The open comminuted distal radius is poorly managed by bridging external fixation with soft tissue irritation by pins and excessive traction required to align fragments. In relatively clean open comminuted fractures I prefer acute bridge plate stabilisation. There are bespoke plates designed for this purpose, however a standard small fragment 12 or 14 hole LCP can be placed under the second extensor compartment using a dorsal Thompson approach to the radius shaft proximal to the APL muscle belly and sliding the plate distally. Care should be taken to avoid eccentric screw placement in the index metacarpal shaft to reduce the risk of per-implant fracture.
In my experience the plater can be applied in 15 minutes – similar to an external fixator. The benefit is that no subsequent conversion of an external fixator to internal fixation is required and the plate can simply be removed at 8 weeks.No plaster or splint is needed and there is no risk of injury from fixator pins in competitive and non-compliant head-injured patients after weaning from a ventilator. I have found the results to be so consistently good that I now offer this technique in the severely comminuted distal radius intra-articular fracture in the osteoporotic patient where definitive internal fixation seldom achieves robust fixation: https://www.ncbi.nlm.nih.gov/pubmed/31040029
I’ve used this technique increasingly frequently and it has essentially replaced an external fixator in my practice.
I am currently using a LCP plate but am interested to see that a number of manufacturers are bringing out low profile bridging plates that are pre-countoured to sit across the wrist.
I agree, I haven’t used an external fixator at the wrist for several years now. I have no experience of the bespoke plates to date but am interested to hear others views on these implants. Have you experienced any tendon ruptures from bridge plating of the distal radius?