Bridge plates in the proximal ulna can be inserted through an open exposure with minimal soft-tissue damage. In open bridge plating, it is important to preserve soft-tissue attachments to the fracture fragments.
A bridge plate may be applied to medial, lateral, or posterior surfaces of the proximal ulna. The choice depends on other injuries, soft-tissue condition and surgeon’s preference. Positioning the plate posteriorly facilitates the sagittal reduction although is slightly more prominent.
Bridge plating can be done with a minimally invasive approach, which requires fluoroscopic monitoring. In minimally invasive surgery, a bridge plate is applied through one proximal and one distal incision, just wide enough for the plate. Control of reduction may be more difficult than with an atraumatic open technique.
Note: In healthy bone, it is not necessary to fill all screw holes proximal and distal to the fracture zone. However, in osteoporotic bone it is safer to use all plate holes outside the fracture zone, or to use an LCP. Multiple screws add torsional stability and decrease the risk of failure.