Intra-articular reduction may be further adjusted by using limited periarticular incisions to allow: direct manipulation of articular fragments; placement of subchondral bone graft; repair of intercarpal ligament injuries; and augmentation of fractures with K-wires, Buttress Pins, Hook Plates or Pin Plates. Displaced volar ulnar corner fragments that are not reduced with the Bridge Plate alone require buttress support.
The DRUJ is assessed and if stable, then the limb is immobilized in a long arm splint with the forearm in 60° of supination for the first 10-14 days. If unstable, then repair or reconstruction of the DRUJ and triangular fibrocartilage complex is undertaken. In rare instances where the patient’s condition does not allow prolonging the operation, manually reduce the ulnar head into the sigmoid notch and pass at least two 1.6mm K-wires through the ulna into the radius proximal to the DRUJ.
Digit range of motion exercises start within 24 hours. Load bearing through the forearm and elbow is allowed immediately, as well as the use of a platform crutch when the patient is physiologically stable. At 1 month postoperatively the platform is removed and weight bearing is allowed through the hand grip of regular crutches. Lifting and carrying is restricted to approximately 10 lbs. until the fracture has healed.
DRUJ stability and forearm motion are assessed at 2 weeks. If the patient can supinate the forearm with little effort and the DRUJ is stable, then splinting is discontinued. Axial loading through the extremity is allowed for transfers and all weight-bearing needs. If supination is difficult or if the DRUJ was reconstructed acutely, then a removable long arm splint is fabricated. If the DRUJ was transfixed with K-wires, then the wires are removed on the third postoperative week and DRUJ stability is reassessed. Supplemental K-wires for articular fixation are removed 6 weeks postoperatively. The plate and screws are removed usually no earlier than 12 weeks after injury.
At the time of hardware extraction the screws are removed and the plate slid from the incision. If resistance is encountered, then axially twist the plate 720 degrees to break up any soft tissue adhesions and callus that grow around edges of the plate. This maneuver is not usually required when the smooth-edged stainless steel plates are used. A removable short arm splint is worn for 2 to 3 weeks after plate removal. Hand therapy at this point is directed at regaining motion and strength.