Abstract:
A distal radial plate including a longitudinal segment having a proximal end and a distal end; a transverse segment having a lateral end and a medical end; the distal end of the longitudinal segment attached to the transverse segment intermediate the lateral and medial ends of the transverse segment to form a T-shape; the longitudinal segment having a plurality of spherically recessed holes and having a slot with a proximal end and a distal end; the distal end of the slot having a spherical recess; the proximal end of the slot having a beveled edge which converges distally with the spherical recess of the slot; the transverse segment having a plurality of spherically recessed holes. An extender seats in one of the holes in the transverse segment of the distal radial plate and provides an additional hole on the lateral side of the transverse segment of the plate. Buttress pins have specially formed collars to be secured to the distal radial plate via a “snap-lock.” A slotted-style distal radial plate bender has slots for receiving and bending both the transverse and longitudinal segments of the distal radial plate.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     Not Applicable. 
     STATEMENT RE FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     Not Applicable. 
     REFERENCE TO A “MICROFICHE APPENDIX” 
     Not Applicable. 
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates, in general, to bone plating systems and, more specifically, to a plating system for fractures of the distal radius. 
     2. Information Disclosure Statement 
     Fracture of the distal radius frequently occurs in humans. Such fractures are commonly treated using standard immobilizing cast techniques. Problems associated with such casts including the failure to secure the fracture result in a relatively high rate of deformity, pain, and prolonged disability. External fixation devices utilizing bone pins are used to treat severe distal radial fractures. However, complications, including infection at the pin track sites, joint stiffness, etc., can occur with external fixation devices. Another method used to treat distal radial fractures include surgically exposing the fracture and then using plates, wires, or other internal fixation devices to fix the fracture. However, such internal fixation methods often require a secondary surgery due to tendon irritation and wear caused by the internal devices. 
     A preliminary patentability search produced the following patents which appear to be relevant to the present invention: 
     Carter, U.S. Pat. No. 5,006,120, issued Apr. 9, 1991, discloses a bone fixation set for the treatment of distal radial fractures. The set includes a plate having conuntersunk bone screw holes and a bland constructed for placement in the capitate of the radius. 
     Medoff, U.S. Pat. No. 5,931,839, issued Aug. 3, 1999, discloses an implantable element for fixation of one or more fractured bone fragments to a stable bone fragment. The element includes a pin plate which is fixed to the stable bone fragment by one or more screws, and one or more pins for passing through the pin plate and loose bone fragments, and into the stable bone fragment. 
     Carter et al., U.S. Pat. No. 5,935,128, issued Aug. 10, 1999, discloses a orthopaedic template system for use with a low profile radius plate. 
     Nothing in the known prior art discloses or suggests the present invention. For example, nothing in the known prior art discloses or suggests a distal radial plate including a longitudinal segment having a proximal end and a distal end, and a transverse segment having a lateral end and a medial end with the distal end of the longitudinal segment attached to the transverse segment intermediate the lateral and medial ends of the transverse segment to form a T-shape, with the longitudinal segment having a plurality of spherically recessed holes and having a slot with a proximal end and a distal end, with the distal end of the slot having a spherical recess, with the proximal end of the slot having a beveled edge which converges distally with the spherical recess of the slot, and with the transverse segment having a plurality of spherically recessed holes. 
     BRIEF SUMMARY OF THE INVENTION 
     The bone plating system of the present invention is designed to give a surgeon a low contour, stainless steel, and volar distal radius plating system for both intra- and extra-articular fractures of the distal radius, while preserving the strength of the current more bulky prior art distal radial plating systems. Other objects of the bone plating system of the present invention is to provide specially designed screws with low profile heads to complement the plates and reduce tendon irritation and wear, provide buttress pins for comminuted fragments that otherwise would not hold a screw; provide an optional lateral extender to obtain fixation of radial styloid fragments; and provide a compression slot for the reduction of extra-articular fractures. 
     An impetus behind the bone plating system of the present invention is to restore intra-articular congruity while avoiding the need for a secondary surgery due to plate-derived tendon irritation and wear. There is close contact between extensor and flexor tendons and the distal radius shaft. It has been reported that even a slightly damaged screw is mechanically capable of irritation and can be made responsible for a scrub-necrosis. Plates that do not have a low contour or that are too thick can alter the tendons&#39; passage resulting in a second surgery to remove the plate and repair a ruptured tendon. Prior art distal radius plating systems have been shown to cause tendon irritation and/or rupture leading to their subsequent removal. The present invention utilized thin, high strength stainless steel plates with low profile screws to avoid these types of complications. 
    
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
     FIG. 1 is a top plan view of a small, left distal radial dorsal plate of the bone plating system of the present invention, the small, right distal radial dorsal plate is a mirror image thereof. 
     FIG. 2 is a first side elevational view of the dorsal plate of FIG.  1 . 
     FIG. 3 is a bottom plan view of the dorsal plate of FIG.  1 . 
     FIG. 4 is a second side elevational view of the dorsal plate of FIG.  1 . 
     FIG. 5 is a distal end view of the dorsal plate of FIG.  1 . 
     FIG. 6 is a proximal end view of the dorsal plate of FIG.  1 . 
     FIG. 7 is an enlarged view of a portion of FIG. 1, showing a spherically recessed longitudinal slot thereof. 
     FIG. 8 is a sectional view substantially as taken on line  8 — 8  of FIG. 1, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 9 is a sectional view substantially as taken on line  9 — 9  of FIG. 1, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 10 is a top plan view of a large, left distal radial dorsal plate of the bone plating system of the present invention, the large, right distal radial dorsal plate being a mirror image thereof. 
     FIG. 11 is a first side elevational view of the dorsal plate of FIG.  10 . 
     FIG. 12 is a bottom plan view of the dorsal plate of FIG.  10 . 
     FIG. 13 is a second side elevational view of the dorsal plate of FIG.  10 . 
     FIG. 14 is a distal end view of the dorsal plate of FIG.  10 . 
     FIG. 15 is a proximal end view of the dorsal plate of FIG.  10 . 
     FIG. 16 is an enlarged view of a portion of FIG. 10, showing a spherically recessed longitudinal slot thereof. 
     FIG. 17 is a sectional view substantially as taken on line  17 — 17  of FIG. 10, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 18 is a sectional view substantially as taken on line  18 — 18  of FIG. 10, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 19 is a top plan view of a universal distal radial volar plate of the bone plating system of the present invention. 
     FIG. 20 is a first side elevational view of the volar plate of FIG.  19 . 
     FIG. 21 is a bottom plan view of the volar plate of FIG.  19 . 
     FIG. 22 is a second side elevational view of the volar plate of FIG.  19 . 
     FIG. 23 is a distal end view of the volar plate of FIG.  19 . 
     FIG. 24 is a proximal end view of the volar plate of FIG.  19 . 
     FIG. 25 is an enlarged view of a portion of FIG. 19, showing a spherically recessed longitudinal slot thereof. 
     FIG. 26 is a sectional view substantially as taken on line  26 — 26  of FIG. 19, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 27 is a sectional view substantially as taken on line  27 — 27  of FIG. 19, on an enlarged scale and with portions thereof broken away for clarity. 
     FIG. 28 is as a top plan view of a distal radial plate extender of the bone plating system of the present invention. 
     FIG. 29 is a first side elevational view of the distal radial plate extender of FIG. 28, the second side being a mirror image thereof. 
     FIG. 30 is a first end view of the distal radial plate extender of FIG.  28 . 
     FIG. 31 is a bottom plan view of the distal radial plate extender of FIG.  28 . 
     FIG. 32 is a proximal end view of the distal radial plate extender of FIG.  28 . 
     FIG. 33 is a sectional view substantially as taken on line  33 — 33  of FIG.  28 . 
     FIG. 34 is a top plan view of a buttress pin of the bone plating system of the present invention. 
     FIG. 35 is a sectional view substantially as taken on linen  35 — 35  of FIG.  34 . 
     FIG. 36 is a front elevational view of the buttress pin of FIG. 34, the rear and side elevational views being substantially mirror images thereof. 
     FIG. 37 is a bottom plan view of the buttress pin of FIG.  34 . 
     FIG. 38 is a top plan view of a buttress pin with soft tissue suture anchor means of the bone plating system of the present invention. 
     FIG. 39 is a sectional view substantially as taken on line  39 — 39  of FIG.  38 . 
     FIG. 40 is a front elevational view of the buttress pin of FIG. 38, the rear and side elevational views being substantially mirror images thereof. 
     FIG. 41 is a sectional view substantially as taken on line  41 — 41  of FIG.  40 . 
     FIG. 42 is a bottom plan view of the buttress pin of FIG.  38 . 
     FIG. 43 is a top plan view of a buttress pin screw lock pin shank of the bone plating system of the present invention. 
     FIG. 44 is a sectional view substantially as taken on line  44 — 44  of FIG.  43 . 
     FIG. 45 is a sectional view substantially as taken on line  45 — 45  of FIG.  43 . 
     FIG. 46 is a front elevational view of the screw lock pin shank of FIG. 43, the rear and side elevational views being substantially mirror images thereof. 
     FIG. 47 is a bottom plan view of the screw lock pin shank of FIG.  43 . 
     FIG. 48 is a perspective view of the screw lock pin shank of FIG.  43 . 
     FIG. 49 is a top plan view of a buttress pin screw lock pin head of the bone plating system of the present invention. 
     FIG. 50 is a sectional view substantially as taken on line  50 — 50  of FIG.  49 . 
     FIG. 51 is a front elevational view of the screw lock pin head of FIG. 49, the rear and side elevational views being substantially mirror images thereof. 
     FIG. 52 is a bottom plan view of the screw lock pin head of FIG.  49 . 
     FIG. 53 is a perspective view of the screw lock pin head of FIG.  49 . 
     FIG. 54 is a top plan view of a slotted plate bender of the bone plating system of the present invention. 
     FIG. 55 is a side elevational view of the slotted plate bender of FIG. 54, the other side being a mirror image thereof. 
     FIG. 56 is a bottom plan view of the slotted plate bender of FIG.  54 . 
     FIG. 57 is a sectional view substantially as taken on line  57 — 57  of FIG.  54 . 
     FIG. 58 is a left end view of the slotted plate bender of FIG.  54 . 
     FIG. 59 is a right end view of the slotted plate bender of FIG.  54 . 
     FIG. 60 is a normal view of a portion of the slotted plate bender of FIG. 54, substantially as taken on line  60 — 60  of FIG. 55 on a somewhat enlarged scale. 
     FIG. 61 is a normal view of a portion of the slotted plate bender of FIG. 54, substantially as taken on line  61 — 61  of FIG. 55 on a somewhat enlarged scale. 
     FIG. 62 is a front plan view of a drill guide of the bone plating system of the present invention. 
     FIG. 63 is a side elevational view of the drill guide of FIG. 62, the other side being substantially a mirror image thereof. 
     FIG. 64 is a rear plan view of the drill guide of FIG.  62 . 
     FIG. 65 is a top plan view of the drill guide of FIG.  62 . 
     FIG. 66 is a bottom plan view of the drill guide of FIG.  62 . 
     FIG. 67 is a sectional view substantially as taken on line  67 — 67  of FIG. 62, on a somewhat enlarged scale. 
     FIG. 68 is a somewhat diagrammatic dorsal view of the distal end of a radius, showing a small, right distal radial dorsal plate of the bone plating system of the present invention attached thereto, with parts thereof omitted for clarity. 
     FIG. 69 is a somewhat diagrammatic sectional view substantially as taken on line  69 — 69  of FIG. 68, with portions thereof broken away for clarity. 
     FIG. 70 is a somewhat diagrammatic sectional view substantially as taken on line  70 — 70  of FIG. 68, with portions thereof omitted for clarity. 
     FIG. 71 is a somewhat diagrammatic volar view of the distal end of a radius, showing a universal distal radial volar plate of the bone plating system of the present invention attached thereto, with parts thereof omitted for clarity. 
     FIG. 72 is a somewhat diagrammatic sectional view substantially as taken on line  72 — 72  of FIG.  71 . 
     FIG. 73 is a somewhat diagrammatic sectional view substantially as taken on line  73 - 71  of FIG. 71, with portions thereof omitted for clarity. 
     FIG. 74 is a somewhat diagrammatic dorsal view of the distal end of a radius, showing a small, right distal radial dorsal plate and a distal radial plate extender of the bone plating system of the present invention attached thereto, with parts thereof omitted for clarity. 
     FIG. 75 is a somewhat diagrammatic sectional view substantially as taken on line  75 — 75  of FIG. 74, with portions thereof broken away for clarity. 
     FIG. 76 is a somewhat diagrammatic sectional view of a portion of a longitudinal segment of the small, left distal radial dorsal plate, showing a low profile head bone screw securing the dorsal plate to a radius. 
     FIG. 77 is a somewhat diagrammatic sectional view of a portion of a transverse segment of the small, left distal radial dorsal plate, showing a buttress pin securing the dorsal plate to a radius. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The preferred embodiment of the bone plating system of the present invention is used for both intra- and extra-articular fractures of the distal radius, and may include a small, left distal radial dorsal plate as shown generally in FIGS. 1-9 and identified by the numeral  11 ; a small, right distal radial dorsal plate (shown diagrammatically in FIGS. 68-70,  74  and  75 , and being a mirror image of the small, left distal radial dorsal plate  11 ); a large, left distal radial dorsal plate as shown generally in FIGS. 10-18 and identified by the numeral  13 ; a large, right distal radial dorsal plate (not shown but being a mirror image of the large, left distal radial dorsal plate  13 ); a universal distal radial volar plate as shown generally in FIGS. 19-27 and identified by the numeral  15 ; a distal radial plate extender as shown generally in FIGS. 28-33 and identified by the numeral  17 ; a buttress pin as shown generally in FIGS. 34-37 and identified by the numeral  19 ; a buttress pin with soft tissue suture anchor means as shown generally in FIGS. 38-42 and identified by the numeral  21 ; a buttress pin screw lock pin shank and coacting buttress pin screw lock pin head as shown generally in FIGS. 43-48 and  49 - 53 , respectively, and identified by the numerals  23  and  25 , respectively; a slotted plate bender as shown generally in FIGS. 54-61 and identified by the numeral  27 ; and a drill guide as shown generally in FIGS. 62-67 and identified by the numeral  29 . 
     The small, left distal radial dorsal plate  11  is preferably substantially T-shaped in plan (see, in general, FIGS.  1  and  3 ). Proximally, the dorsal plate  11  includes a longitudinal segment  32  having a proximal end  33  and a distal end  34 . The longitudinal segment  32  preferably has a plurality of spherically recessed holes  35  to accept bone screws  37  (see FIG.  76 ). This longitudinal segment  32  also has a longitudinal slot  39  for use with bone screws  37  to compress fractures. The longitudinal slot  39  has a distal end  40  and a proximal end  41 . The distal end  40  of this slot  39  has a spherical recess. The proximal end  41  of this slot  39  has a beveled edge which converges distally with the spherical edges or recess of the distal end  40  of the slot  39  to create a compression feature so that as a bone screw  37  with a spherical head is seated against this beveled edge, the plate  11  will slide proximally to seat the head of the screw  37  in the spherically recessed distal portion or end  40  of the slot  39 . Distally, the dorsal plate  11  includes a transverse segment  42  having a lateral end  43  and a medial end  44 . The transverse segment  42  preferably has a plurality of spherically recessed holes  45  to accept buttress pins  19  (see FIG.  77 ), buttress pins  21 , buttress pin screw lock pin shank  23  and pin head  25  combinations, and/or bone screws  37 . The holes  45  preferably have a counterbore  47  on the bottom side of the plate  11  in order to create a locking feature for the buttress pins  19 , buttress pins  21 , and/or buttress pin screw lock pin shank  23  and pin head  25  combinations. The transverse segment  42  preferably has a transverse, recessed slot  49  connected to the hole  45  on the lateral end  43  of this transverse segment  42 , on the bottom face  51  of the plate  11  and which extends laterally from this last hole  45 , increasing in width, through the lateral end  43  of the transverse segment  42 . This slot  49  is used for the addition of an extender  17  which when inserted in this slot  49  can be angled  15  degrees either proximally or distally. This distal transverse segment  42  of the plate  11  also preferably has a central divot  53  which allows visualization of the distal radius articulating surface and in part provides a relief for Lister&#39;s Tubercle. The transverse segment  42  of the plate  11  is preferably angled with respect to the longitudinal segment  32  to further match the anatomy of the distal radius R (see, in general, FIGS.  68  and  74 ). The plate  11  is preferably pre-bent to approximately a 140° angle (see, in general, FIGS. 5 and 6) so that its bottom face  51  conforms as closely as possible to the surface of the distal radius R (see, in general, FIGS.  69  and  70 ). The plate  11  preferably has a low profile and smooth finish so as to minimize tendon irritation. The plate  11  is preferably constructed of a surgical grade stainless steel. More specifically, based on the strength necessary and the clinical history of other currently marketed distal radial plating systems, high strength  316 L stainless steel is preferably used to construct the plate  11  to allow the plate  11  to be constructed as thin as possible and the thinnest material possible without sacrificing strength, and to provide pliability of the plate  11  for precise fitting. 
     As indicated hereinabove, the small, right distal radial dorsal plate is a mirror image of the small, left distal radial dorsal plate  11 , and the above disclosure of the small, left distal radial dorsal plate  11  will provide a full and enabling teaching of the small, right distal radial dorsal plate to one of ordinary skill in the art. The small, right distal radial dorsal plate is shown diagrammatically in FIGS. 68-70,  74  and  75 , with like features identified with the same reference numbers as used for the small, left distal radial dorsal plate  11 . 
     Other than size and one exception discussed hereinbelow, the large, left distal radial dorsal plate  13  is preferably identical in design and construction to the small, left distal radial dorsal plate  11 , and is preferably substantially T-shaped in plan (see, in general, FIGS.  10  and  12 ), with a proximal longitudinal segment  55 , a plurality of spherically recessed holes  57  and a spherically recessed longitudinal slot  59  in the proximal longitudinal segment  55 , a distal transverse segment  61 , a plurality of spherically recessed holes  63  in the distal transverse segment  61 , etc. The above disclosure of the corresponding features, etc., of the small, left distal radial dorsal plate  11  will provide a full and enabling teaching of such features, etc., for the large, left distal radial dorsal plate to one of ordinary skill in the art. The one exception mentioned hereinabove is that in the large, left distal radial dorsal plate  13 , the lateral end of the distal transverse segment  61  is extended proportionally a greater distance from the proximal longitudinal segment  55  than the lateral end  43  of the distal transverse segment  42  is extended from the proximal longitudinal segment  32  of the small, left distal radial dorsal plate  11 , and an additional spherically recessed hole  63  is provided through the lateral end  43  of the distal transverse segment  42 . 
     As indicated hereinabove, the large, right distal radial dorsal plate is a mirror image of the large, left distal radial dorsal plate  13 , and the above disclosure of the large, left distal radial dorsal plate  13  will provide a full and enabling teaching of the large, right distal radial dorsal plate to one of ordinary skill in the art. 
     The universal distal radial volar plate  15  is preferably substantially T-shaped in plan (see, in general, FIGS.  19  and  21 ). Proximally, the volar plate  15  includes a longitudinal segment  65  preferably having a plurality of spherically recessed holes  67  to accept bone screws  37 . This longitudinal segment  65  also has a spherically recessed longitudinal slot  69  for use with bone screws  37  to compress fractures. The proximal end  71  of this slot  69  has a beveled edge which converges distally with the spherical edges of the slot  69  to create a compression feature so that as a bone screw  37  with a spherical head is seated against this beveled edge, the plate  15  will slide proximally to seat the head of the screw  37  in the spherically recessed portion of the slot  69 . Distally, the volar plate  15  includes a transverse segment  73  preferably having a plurality of spherically recessed holes  75  to accept buttress pins  19 , buttress pins  21 , buttress pin screw lock pin shank  23  and pin head  25  combinations, and/or bone screws  37 . The holes  75  preferably have a counterbore  47  on the bottom side of the plate  11  in order to create a locking feature for the buttress pins  19 , buttress pins  21 , and/or buttress pin screw lock pin shank  23  and pin head  25  combinations. This distal transverse segment  73  of the plate  15  also preferably has a central divot  77 . The distal end of the plate  15  is preferably pre-bent to approximately a 155° angle (see, in general, FIGS. 20 and 22) so that its bottom face  79  conforms as closely as possible to the surface of the distal radius R (see, in general, FIG.  72 ). The plate  15  preferably has a low profile and smooth finish so as to minimize tendon irritation. The plate  15  is preferably constructed of a surgical grade stainless steel. More specifically, based on the strength necessary and the clinical history of other currently marketed distal radial plating systems, high strength 316L stainless steel is preferably used to construct the plate  15  to allow the plate  15  to be constructed as thin as possible and the thinnest material possible without sacrificing strength, and to provide pliability of the plate  15  for precess fitting. The volar plate  15  is not side specific and may be offered in only one size. 
     The distal radial plate extender  17  mates with the bottom side of, e.g., the small, left distal radial dorsal plate  11  (or the large, left distal radial dorsal plate  13 , or the small or large right distal radial dorsal plates) to provide an additional hole on the lateral side of the head or transverse segment  42  of the dorsal plate  11 , etc. The extender  17  preferably has a first end  81 , a second end  83 , and a midportion  85  joining the first and second ends  81 ,  83 . The second end  83  has a boss portion  86  sized to extend into and seat in the most distal spherically recessed hole  45  in the dorsal plate  11 , with the midportion  85  located in the transverse, recessed slot  49 , etc. The distal radial plate extender  17  preferably has a first spherically recessed hole  87  in the first end  81  thereof and a second spherically recessed hole  89  in the second end  83  thereof. The distal radial plate extender  17  eliminates the trimming and filing debris associated with an attached hole found in other systems. Connection of the distal radial plate extender  17  through the transverse, recessed slot  49  allows angulation of the distal radial plate extender  17  for better proximal/distal position of the extender hole  87 . The distal radial plate extender  17  is preferably constructed out of stainless steel. 
     The buttress pins  19 ,  21  and buttress pin combination  23 ,  25  are for use with a fracture fixation plate, specifically a distal radial dorsal or volar plate as disclosed herein, for the positioning of small bone fragments (the following description of the buttress pins  19 ,  21  and buttress pin combination  23 ,  25  will be in combination with the small, left distal radial dorsal plate  11  but it should be understood that the buttress pin  19 ,  21  and buttress pin combination  23 ,  25  are not limited for use with the small, left distal radial dorsal plate  11 ). Each buttress pin  19 ,  21  and the buttress pin screw lock pin shank  23  includes a shank  91  for extending through one of the spherically recessed holes  45  in the transverse segment  42  of the distal radial dorsal plate  11 , and into a bone fragment of the distal radius R (see, for example, FIG.  77 ). Each buttress pin  19 ,  21  and the buttress pin screw lock pin shank  23  includes a collar  93  attached to the shank  91  for locking the distal radial dorsal plate  11  to the corresponding buttress pin  19 ,  21  or buttress pin screw lock pin shank  23 . The collar  93  has a recessed groove  95  thereabout and is movable between a first position for allowing the collar  93  to be inserted into one of the spherically recessed holes  45  in the transverse segment  42  of the distal radial dorsal plate  11 , and a second position in which the recessed groove  95  of the collar  93  captures at least a portion of the edge of that spherically recessed hole  45  in the transverse segment  42  of the distal radial dorsal plate  11  to lock the distal radial dorsal plate  11  and the corresponding buttress pin  19 ,  21  or buttress pin screw lock pin shank  23  together. The head or collar  93  will thus interlock with the hole  45  vial a “snap-lock.” The collar  93  of the buttress pins  19 ,  21  may have a slot  97  (preferably a pair of intersecting slots  97  as clearly shown in FIGS. 34 and 38) therein to allow the collar  93  to be compressed to the first position when inserted into a spherically recessed hole  45  in the transverse segment  42  of the distal radial dorsal plate  11  and to expand or spring back to the second position with the recessed groove  95  of the collar  93  capturing at least a portion of the edge of that spherically recessed hole  45  in the transverse segment  42  of the distal radial dorsal plate  11 . The collar  93  of the buttress pins  19 ,  21  may have a plurality of divots  99  (preferably four opposing divots  99 ) for allowing the collar  93  to be compressed from the second position to the first position (I.e., for use in the compression and removal of the pins  19 ,  21  from the distal radial dorsal plate  11 ). The buttress pin  21  includes means for allowing the pin to be attached to soft tissue. More specifically, the buttress pin  21  preferably has a hole  101  through the shank  91  thereof just beneath the collar  93  thereof for allowing a suture to extend therethrough to attach the buttress pin  21  to soft tissue. The buttress pin screw lock pin head  25  is designed to extend into at least the collar  93  of the buttress pin screw lock pin shank  23  to cause that collar  93  to move from the first position to the second position. The buttress pin screw lock pin head  25  preferably has a male screw portion  103 , and the buttress pin screw lock pin shank  23  preferably has a internally threaded aperture  105  in the collar  93  and shank  91  thereof for receiving the screw portion  103  whereby screwing the screw portion  103  into the internally threaded aperture  105  causes the collar  93  to expand from the first position to the second position. The buttress pin screw lock pin shank  23  is first inserted into the desired hole  45  in the transverse segment  42  of the distal radial dorsal plate  11  until the collar  93  thereof “snaps-in” the hole  45  and the screw lock pin head  25  is then screwed into the screw lock pin shank  23  and tightened, causing the collar  93  to expand and locking the unit ( the buttress pin combination  23 ,  25  and the distal radial dorsal plate  11 ) together in a very solid connection. The buttress pins  19 ,  21  and buttress pin combination  23 ,  25  are preferably constructed out of stainless steel. 
     The slotted plate bender  27  is designed for use in bending and molding a fracture fixation plate to match the anatomy of a specific radius R. The plate bender  27  is specifically designed for use with a distal radial dorsal or volar plate as disclosed herein and the following description of the plate bender  27  will be in combination with the small, left distal radial dorsal plate  11  but it should be understood that the plate bender  27  is not limited for use with the small, left distal radial dorsal plate  11 . The plate bender  27  includes an elongated, preferably round, handle  107  having a first end  109  and a second end  111 . The plate bender  27  includes a tip  113  attached to the first end  109  of the elongated handle  107  at an angle thereto. The tip  113  has an end surface  115  and a face surface  117  substantially perpendicular to the end surface  115 . The tip  113  has a first slot  119  extending through the end surface  115  for receiving an end of the transverse segment  42  of the plate  11 , and has a plurality of slots  121  extending through the face surface  117  thereof for receiving an end of the longitudinal segment  32  of the plate  11 , or the longitudinal segment  65  or transverse segment  73  of the volar plate  15 . The angled tip  113 , in combination with the elongated handle  107 , provides leverage for bending the plate  11 . At least portions of the surface of the handle  107  may be knurled or otherwise formed to provide a secure grip. The plate bender  27  is preferably constructed out of stainless steel. 
     The drill guide  29  shown in FIGS. 62-67 includes an elongated, substantially flat body  123  having an upturned first end  125  and an upturned second end  127  Each end  125 ,  127  has an aperture  129  therethrough to allow a drill guide tip  131  to be inserted thereinto. Grooves  133  may be provide on the surface of the body  123  to allow the surgeon to securely grip the drill guide  29 . The drill guide tips  131  are provided in various sizes depending on the size of screw, buttress pin, etc., to be used. 
     Operative exposure of a distal radial fracture becomes necessary if acceptable reduction cannot be achieved by closed means in those high-energy injuries in which extensive soft tissue or associated skeletal injury requires stable fixation of the distal radius. 
     To use the bone plating system of the present invention with a dorsal approach, typically a straight longitudinal incision is made over the dorsal radius between the second and third dorsal extensor compartments and extending between 7 and 12 centimeters. The fracture can then be identified and exposed, and the structures retracted on both sides of the distal radial shaft. At that time, under direct vision, the fracture can be confirmed, reduced and/or brought out to length with distraction to verify this. After ensuring reduction through distraction or manual manipulations and with fluoroscopic X-rays, the surgeon can then decide what size plate  11 ,  13 , etc., to use and if an extender  17  will be needed due to any floating radial styloid fragments. A malleable template of the selected plate  11 ,  13 , etc., can then be placed and used to determine the appropriate contour of the fractured radius R. Removal of the Lister&#39;s tubercle may be necessary. The bender  27  can then be used to match the selected plate  11 ,  13 , etc., to the contoured template. Care should be taken not to bend the selected plate  11 ,  13 , etc., across the holes  45 , etc., designed for use with buttress pins  19 ,  21  or buttress pin combinations  23 ,  25 . Appropriate screw size as well as screw and pin placement can then be determined. Screw and pin holes must be predrilled in the radius R with the appropriate drill and drill guide  29 . The screws should be self-tapping and can be inserted directly into their corresponding drilled holes. The buttress pins  19 ,  21  or buttress pin combinations  23 ,  25  will interlock with the plate  11 , etc., once inserted into their corresponding drilled holes. A firm push on the head of the buttress pin  19 ,  21  or buttress pin combination  23 ,  25  will “snap” the head into the plate  11 , etc. Note: the buttress pins  19 ,  21  and buttress pin combinations  23 ,  25  are designated for the holes  45  in the transverse segment  42  of the plate  11 , etc. Additionally, the buttress pins  19 ,  21  and buttress pin combinations  23 ,  25  are not to be used to either attach the extender  17  to the plate  11 , etc., or with the hole  89  in the extender  17 . If compression of the fracture is necessary, the compression slot  39  in the middle of the longitudinal segment  32  of the plate  11 , etc., may be used. A hole is drilled at the proximal end  41  of the slot  39 , etc., so that as a screw is seated against the proximal end  41  of the slot  39 , the head of the screw will pull the entire plate proximally. 
     To use the bone plating system of the present invention with a palmar approach, an appropriate surgical approach is used with regard to the anterior aspect of the distal radius to provide adequate exposure while protecting the median and ulnar nerves, flexor tendons, and palmar capsular radiocarpal ligaments. The fracture can then be identified and exposed, and the structures are retracted on both sides of the distal radial shaft. Then, under direct vision, the fracture is confirmed, reduced and/or brought out to length with distraction to verify this. After ensuring reduction through distraction or manual manipulation and with fluoroscopic X-rays, a surgeon can then place and contour the volar plate  15 . Care should be taken not to bend the volar plate  15  across the holes  75  designated for use with buttress pins. Attachment of the plate  15  with screws and buttress pins, etc., can follow the same procedures described hereinabove relative to the dorsal approach. 
     Although the present invention has been described and illustrated with respect to a preferred embodiment and a preferred use therefor, it is not to be so limited since modifications and changes can be made therein which are within the full intended scope of the invention.