Bridge plating uses the plate as an extramedullary splint, fixed to the two main fragments, while the intermediate fracture zone is left untouched. Anatomical reduction of the shaft fragments is not necessary, but it is essential to restore length, axial alignment and rotation.
Furthermore, direct manipulation of the intercalary fragments risks disturbing their blood supply. If the soft-tissue attachments are preserved, and the fragments are relatively well aligned, healing is predictable.
Alignment of the main shaft fragments can usually be achieved indirectly, utilizing traction and soft-tissue tension.
If the fibula has a simple fracture pattern, direct reduction of this fracture can provide an indirect reduction of the tibia, establishing length and approximate rotational and axial alignment. For this reason, plate fixation of the fibula is commonly performed prior to bridge plating of appropriate tibia fractures.
Mechanical stability, provided by the bridging plate, is adequate for indirect healing (callus formation).
This minimally invasive surgery requires the use of an image intensifier.