Trans-articular Bridge Plating for Gunshot-related Periarticular Hand Fractures

The increasing incidence of civilian firearm-related injuries has placed a growing burden on hand surgeons to manage complex ballistic trauma. Periarticular hand fractures caused by firearms present a particularly difficult treatment challenge, characterized by articular comminution, bone loss, and concurrent soft tissue injury. These features frequently render standard fixation options, including plate fixation, wire pinning, and external fixation, either technically infeasible or prone to complication. This manuscript describes our technique of dorsal trans-articular bridge plating as a salvage option for gunshot-related periarticular fractures at the metacarpophalangeal and proximal interphalangeal joints of the hand. Originally developed for severely comminuted intra-articular distal radius fractures, bridge plating achieves relative reduction through ligamentotaxis while providing a robust, length-stable construct with minimal additional soft tissue disruption. We present a retrospective case series of 14 patients treated at a level 1 urban trauma center between 2021 and 2023. Nine underwent trans-articular bridge plating at the MCP joint and 5 at the PIP joint. Of the 11 patients with available postoperative data, 91% achieved radiographic fracture union. Mean pain scores improved from 5.6 of 10 at initial follow-up to 1.4 of 10 at final follow-up (mean 6.7 mo after hardware placement). Postoperative stiffness was encountered in all patients, reflecting the severity of the underlying injury. Trans-articular bridge plating is a technically reproducible salvage option for severely comminuted gunshot-related periarticular hand fractures, offering reliable restoration of digital length, alignment, and rotation with acceptable early outcomes.