In Reply:

Abstract

We understand the reader's confusion regarding the discrepancy between the Soong grading system1Soong M. Earp B.E. Bishop G. et al.Volar locking plate implant prominence and flexor tendon rupture.J Bone Joint Surg Am. 2011; 93: 328-335Crossref PubMed Scopus (192) Google Scholar and measurements for the plate-to-critical line distance and the plate-to-volar rim distance. The Soong grading system is a qualitative grading system based on the position of the volar plate relative to the volar critical line and the volar rim. In our study, 6 of 8 patients with tendon ruptures were classified as Soong grade 2 by all graders who were blinded to the study protocol, because their volar plates extended to the level of the volar rim or beyond. The quantitative plate-to-critical line distance and plate-to-volar rim distance measurements were performed separately by these graders and the Soong grading data were not altered based on the values of the quantitative measurements. After initial analysis of the data, 2 of 8 patients with tendon ruptures had plate-to-volar rim distance values less than or equal to 0; these patients were classified as Soong grade 2. An additional 4 of 8 patients with ruptures had distal plates that extended less than 1 mm from the volar rim. These 4 patients are the source of the readers' confusion, because they were also classified as Soong grade 2 when the qualitative Soong grading was performed separately. The quantitative measurements are more precise, which was a driving factor in our decision to pursue this study. Despite the discrepancy between the qualitative and quantitative measurements, we thought it was important to include the Soong grading system in our study because it was a previously published and accepted grading system. Letter Regarding “Volar Plate Position and Flexor Tendon Rupture Following Distal Radius Fracture Fixation”Journal of Hand SurgeryVol. 38Issue 11PreviewWe read with great interest the article by Kitay et al,1 published in the June 2013 issue of the Journal of Hand Surgery. The authors measured the plate-to-critical line distance (PCL), plate-to-volar rim distance (PVR), and graded plate prominence relative to the volar critical line using the Soong grading system.2 The PCL is measured with negative values for plates dorsal to the critical line, and positive values for prominent plates volar to the critical line. The PVR is measured with positive values for plates proximal to the volar rim, and negative values for plates distal to the volar rim. Full-Text PDF