The plate is contoured and any extra holes are removed. When inserting the screws (in the proximal row, adjacent to the talonavicular joint), care must be taken to prevent the screws from entering the dome-shaped joint. In the case of the newer generation variable-angle locking plates, the screws should be aimed distally, away from the talonavicular joint. This can also be accomplished by contouring non variable-angle locking plates, or using non-locking plates.
In the case of severely comminuted fractures where stable / rigid internal fixation is not certain, the distractors can be replaced with an external fixator which can then be left in place while the bone heals.