Inadvertent Retention of Angled Drill Guides After Volar Locking Plate Fixation of Distal Radial Fractures

Abstract

Advances in locking plate technology have proven especially valuable for fixation of distal radial fractures, and preliminary results have been excellent1-6. However, new technology can sometimes lead to new complications. In some systems, the locking plates are preloaded with angled drill guides to allow for easy placement of locking screws in the proper direction (Fig. 1). The drill guides are designed to be removed prior to closure. We report the cases of three patients in whom the angled drill guides were retained after surgery. Institutional review board approval was obtained for this study, and the patients were informed that data concerning the case would be submitted for publication, and they consented. Fig. 1 The Hand Innovations Distal Volar Radius (DVR) locking plate. The proximal and distal rows are preloaded with angled drill guides. Case 1. A sixty-three-year-old woman sustained a closed distal radial fracture after a fall. Attempted closed reduction was unacceptable, and the patient elected to proceed with open reduction and internal fixation. Fixation consisted of open reduction and application of a Distal Volar Radius (DVR) plate (Hand Innovations, Miami, Florida) with use of intraoperative fluoroscopy. The first formal radiographs were obtained at two-week follow-up in the office showing three retained drill guides. The patient was offered surgery to remove the guides but declined. By six weeks after the operation, she had attained full range of motion of the wrist and had returned to work with no pain. Nine months postoperatively, she presented …