Implant prominence and flexor tendon rupture in distal radial fractures using volar locking plate technology: a retrospective chart review

Abstract

Background: Volar locking plate (VLP) fixation, an accepted treatment for distal radial fractures, has the known complication of flexor tendon rupture, theorized to be caused by implant positioning. Although implant position is a suspected risk factor, incidence of tendon rupture may be less than previously reported. This study investigated implant prominence and its relation to tendon rupture. Methods: Surgical records of 197 patients who underwent repair of distal radial fractures using VLP fixation between July 2014 and December 2017 were retrospectively reviewed. Pre- and postoperative radiographs were used to assign AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification and implant prominence using the Soong classification. Chi square and Fisher’s Exact Tests compared Soong groups to fracture classification, hand function, and reoperation. A phone survey was used to determine finger function. Results: Eleven patients underwent reoperation, six for tendon irritation with no tendon ruptures. Fracture classification (P=0.601) and Soong grade (P=0.687) showed no difference when compared with reoperation. There was a difference (P=0.039) comparing fracture classification to Soong classification, with higher fracture classification associated with higher Soong classification. No difference (P>0.05) for finger function was found between either group. Conclusions: Flexor tendon rupture historically has been linked to VLP fixation in distal radial fractures. This study found tendon rupture was not associated with fracture classification or implant prominence and had a lower incidence than previously reported. Finger function had no relation to fracture classification or implant prominence. This study suggested implant prominence is more likely with increasing fracture complexity with little clinical significance. Level of Evidence: Level IV