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1Principles

Bridge plating

Bridge plating uses the plate as an extramedullary splint, fixed to the two main fragments, and leaving the intermediate fracture zone untouched. Anatomical reduction of intermediate fragments is not necessary. Furthermore, their direct manipulation would risk disturbing their blood supply. If the soft-tissue attachments to the fragments are preserved and the fragments are relatively well aligned, healing is unimpaired.

Alignment of the main shaft fragments can be achieved indirectly with the use of traction and the support of indirect reduction tools, or indirectly via the implant.

Mechanical stability, provided by the bridging plate, is adequate for gentle functional rehabilitation and results in satisfactory indirect healing (callus formation). Occasionally, a larger wedge fragment might be approximated to the main fragments with a lag screw.

Bridge plate insertion
Bridge plates can be inserted either with an open exposure that respects soft-tissue attachments to the fracture, or using a minimally invasive (MIO) approach that leaves the soft tissues intact over the fracture site. In this latter case, incisions are made proximally and distally, and the plate is inserted through a submuscular tunnel. This requires image intensifier monitoring.