Tendon Rupture After Volar Locking Plate Fixation of Distal Radius Fractures

Abstract

Background: The volar locking plate (VLP) has been widely used over the past 2 decades in patients with distal radius fractures (DRFs). However, flexor pollicis longus (FPL) ruptures are a well-known postoperative complication of using the VLP system, although the incidence of tendon ruptures following VLP fixation remains unclear. The purpose of the present study was to assess the frequency of FPL rupture on a large scale in patients with DRFs who were treated with the VLP system. Materials and Methods: A questionnaire was administered by an orthopedic surgeon who performed the surgeries in patients with DRFs in our prefecture. Thirty institutions were enrolled in this study. The questionnaire consisted of 2 parts. The first part comprised the number of patients who underwent surgery using the VLP and the number of patients who suffered a tendon rupture between January 2011 and December 2014. The second part comprised the surgeon’s policy for removing the implant after bone union was achieved. Results: All 30 institutions responded to the first part of the questionnaire, and 50 orthopedic surgeons who were working at the institutions answered the second part of the questionnaire. During the 4-year period, 2787 patients with DRFs underwent fixation using a VLP. The overall incidence of FPL rupture, extensor pollicis longus rupture, flexor digitorum profundus (index finger) rupture, and extensor digitorum communis rupture was 0.35% (10/2787), 0.29% (8/2787), 0.04% (1/2787), and 0.04% (1/2787), respectively. Regarding the question about implant removal, 18 surgeons responded that they removed the implant in almost all cases, 25 answered that they removed the implant depending on the case, and 7 responded that they usually do not remove the implant. Conclusion: This study evaluated 2787 patients with DRFs who underwent fixation using a VLP. FPL rupture occurred in 10 patients (0.35%), whereas other tendon ruptures occurred less often. Implant removal was performed by more surgeons in our prefecture.