Volar Plate Fixation for the Treatment of Distal Radius Fractures

Luigi Tarallo,Fabio Catani,Francesco Zambianchi,Roberto Adani,Raffaele Mugnai

doi:10.1097/bot.0b013e3182913fc5

Abstract

Determining the rate of specific adverse events after volar plating performed for distal radius fractures. Retrospective. University level I trauma center. We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up. Volar plate fixation for the treatment of distal radius fractures. At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation. Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues. The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement. Therapeutic level IV.

Highlights

Locking plate fixation for distal radius and for other fractures has become increasingly popular across the developed world over the past 5 years.[1,2,3] The popularity of this method is based on the stable restoration of the anatomy, short period of immobilization, and early return to previous activity level.[4,5] Previous studies suggest that restoration of normal alignment and articular congruity after a distal radius fracture promotes good functional results[6,7] and prevents the development of late osteoarthritis.[8]
Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally
The majority of adverse events after volar plate fixation were due to technical errors in implant placement

Summary

Introduction

Locking plate fixation for distal radius and for other fractures has become increasingly popular across the developed world over the past 5 years.[1,2,3] The popularity of this method is based on the stable restoration of the anatomy, short period of immobilization, and early return to previous activity level.[4,5] Previous studies suggest that restoration of normal alignment and articular congruity after a distal radius fracture promotes good functional results[6,7] and prevents the development of late osteoarthritis.[8]. Volar plating has gained widespread use.[9,10,11] recent studies report volar plating complication rates as high as 22%–27%.5,12 In this retrospective study, we evaluated the occurrence of adverse events after volar locking plate fixation in a large cohort of patients with unstable fractures of distal radius with long-term follow-up based on the medical records and clinical and radiographic assessment

Objectives

Methods

Results

Discussion

Conclusion