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5Bridge plating or external fixation

Bridge plating

External fixation

In the case of severely comminuted fractures where stable / rigid internal fixation is not assured, instead of bridge plating, the lateral column distractor can be replaced with an external fixation construct which can be left in place while the bone heals.
Supplemental fixation (screw or K-wire) can be placed from the fifth metatarsal (which can be rendered unstable by this injury), through the fourth metatarsal into the third metatarsal, or lateral cuneiform. This will further prevent lateral column shortening.