Flexor Pollicis Longus Rupture Research Articles

Flexor Pollicis Longus Reconstruction After Rupture Following Distal Radius Fixation With Volar Locking Plate: A Technique Guide.

Flexor pollicis longus rupture is an uncommon but potentially debilitating complication after volar locking plate fixation of distal radius fractures, occurring secondary to tendon attrition against the implant. This nature of tendon injury typically precludes primary repair. This paper will illustrate 2 reconstruction techniques, an interpositional tendon graft and a tendon transfer, that have been utilized successfully by the authors.

Flexor Pollicis Longus Rupture After Scaphoid Fracture Repair: A Case Report

Background: Flexor Pollicis Longus (FPL) tendon attritional rupture is a rare diagnosis. Reported causes include distal radius plates, SNAC wrist, steroid injection and CMC1 arthrodesis hardware. We describe an FPL rupture 1 year after scaphoid waist fracture fixation. Case description: A 23-year-old male ruptured his FPL when it abraded on a headless compression scaphoid screw. After full union of the fracture hardware was removed and the ruptured FPL tendon was reconstructed with a palmaris longus graft.

Changes in Distance Between the Flexor Pollicis Longus Tendon and Volar Locking Plate: An Ultrasonographic Study

Flexor pollicis longus rupture is a major complication after volar locking plate fixation of distal radius fractures. Although the distance between the flexor pollicis longus tendon and the plate (plate-tendon distance) measured by ultrasonography is used to predict tendon rupture risk, the timing of the ultrasonography can affect the measurements. Therefore, this study aimed to analyze the chronological change of the plate-tendon distance between the tendon and plate. A total of 166 wrists underwent the plate-tendon distance measurement twice or more times within 15 months after surgery. Longitudinal ultrasonography scans with the wrist in a neutral position and the thumb flexed were used to measure the plate-tendon distance. The plate-tendon distances at 0-5 months, 5-10 months, and 10-15 months after surgery were compared. A multiple linear regression analysis was performed to evaluate the influence of the interval between surgery and examination, Soong grade, and plate type on the plate-tendon distance. The plate-tendon distance decreased as the interval between surgery and examination increased. The plate-tendon distance was an average of 2.0 ± 1.1 mm, 1.4 ± 0.9 mm, and 1.2 ± 0.9 mm at 0-5 months, 5-10 months, and 10-15 months after surgery, respectively. Significant differences were observed between 0-5 months and 5-10 months and between 5-10 months and 10-15 months after surgery. A multiple linear regression showed that significant predictors of the plate-tendon distance were the intervals between surgery and examination and Soong grade. The plate-tendon distance decreased as the time since surgery increased. When ultrasonography is used for the assessment of tendon rupture risk, it should be considered that the plate-tendon distance decreases as the interval between the surgery and examination increases. Prognosis IV.

Wide-awake local anesthesia No tourniquet (WALANT) for reconstruction of flexor pollicis longus ruptures following volar plate fixation of distal radius fractures- A Case series

BackgroundThe flexor pollicis longus tendon rupture following distal radius fractures is a known complication and reconstruction with interposition tendon graft achieved a good outcome. Therefore, this study aims to analyze the outcome of FPL tendon reconstruction using the wide-awake local anesthesia no tourniquet (WALANT) technique. MethodsSeven patients with attritional FPL rupture were retrospectively analyzed between 2014 and 2021. All these patients had FPL reconstruction using palmaris longus interposition graft under WALANT. The patient demographics, Soong volar plate prominence classification, volar plate type, and functional outcome assessment were reviewed. ResultsThe FPL tendon rupture occurred at a mean of 1.1 years (range, 6 months −3 years) following volar plate fixation. The patients had T-buttress (n ​= ​6) and volar locking plates (n ​= ​1). The mean follow-up of our study was 16.5 months (range 12–19 months). The total interphalangeal joint movement, grip strength, pinch strength, and Kapandji score were significantly less than the uninjured hand (p ​< ​0.05). The mean DASH Score was 14 (range 4.5–28). All surgeries were daycare, and WALANT provided effective analgesia and a comfortable patient experience. ConclusionsFPL reconstruction using WALANT achieves a good functional outcome. In addition, the intraoperative assessment of tendon excursion, adjusting the tension, and educating early rehabilitation are the advantages of the WALANT. Level of evidenceIV, Retrospective case study.

Trigger thumb preceding flexor pollicis longus tendon rupture after distal radius volar plate fixation: A case report.

IntroductionFlexor pollicis longus (FPL) tendon rupture is a known complication after a distal radius (DR) fracture and subsequent fixation with a volar plate. A commonly accepted theory is the attrition of the flexor tendon by the prominent volar plate or theoretical injury to the tendon during the initial injury. An increasingly rare complication of distal radius open reduction internal fixation (ORIF) with volar plate fixation is stenosing tenosynovitis, more commonly known as trigger finger.Presentation of caseWe present a case of FPL rupture 7 years after volar plate fixation for DR fracture with thumb triggering in an elderly patient. To treat her trigger thumb, a corticosteroid injection was administered for symptomatic relief. Without resolution of her symptoms, she was scheduled for hardware removal and A1 pulley release. At her preoperative visit, she was found to have a rupture of her FPL tendon.Discussion/conclusionThis case report provides insight into an atypical presentation of delayed-onset FPL rupture and preceding trigger thumb. Especially in individuals with no inciting events, the patient's trigger thumb after volar plate distal radius ORIF may have been a warning sign for impending FPL rupture. This underscores the importance in considering potential tendon attrition as part of a differential diagnosis in a patient presenting with trigger thumb after distal radius ORIF with a volar plate. In assessing for FPL tendon rupture, diagnostic imaging modalities such as ultrasound may be utilized in evaluating this condition to prevent potential loss of function.

Diagnostic ultrasound of tendon injuries in the setting of distal radius fractures.

Describe tendon injuries and their structural causes seen on ultrasound in wrists with distal radius fractures and estimate the accuracy of ultrasound and its impact on clinical management. Ultrasounds of 226 wrists (221 patients) with distal radius fractures were retrospectively reviewed. Ultrasound findings of tendon injuries and their structural causes were correlated with surgery and clinical outcome. Accuracy and inter- and intra-observer reproducibilities were calculated. Twenty-five wrists were treated non-operatively while 201 underwent surgery. Ultrasound demonstrated hardware contact with flexor pollicis longus (FPL) in 76 wrists, extensor pollicis longus (EPL) in 21, and other tendons in 94. Ultrasound identified tendon ruptures in 23 wrists (13 EPL/8 FPL/2 extensor indicis proprius (EIP)), most of which were surgically confirmed. Among 12 wrists with confirmed EPL ruptures, distal radius fracture had been treated with volar plating in 6 and non-operatively in 6, and ultrasound showed osseous irregularity at the rupture site in 8. All FPL ruptures occurred in wrists with volar plating. Ultrasound findings were concordant with subsequent clinical management in most. In 2, ultrasound findings led to the decision to remove hardware despite lack of symptoms. Ultrasound had sensitivity/specificity/accuracy of 88/99/98% for identifying a specific tendon as ruptured and 88/87/88% for tendon abnormalities in general. Inter- and intra-observer reproducibilities were excellent (kappa = 0.85 ~ 1.0). Certain wrist tendons, particularly EPL and FPL, are vulnerable after distal radius fractures. Ultrasound is accurate and useful for detecting tendon injury and sources of tendon irritation and can guide clinical management.

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation.Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs.Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75).Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.

Analysis of risk factors associated with flexor pollicis longus injury after volar plating of distal radius fractures.

ObjectiveThis study was performed to analyze the risk factors associated with flexor pollicis longus (FPL) attrition or rupture after volar plating of distal radius fractures.MethodsThree hundred thirty-eight patients with distal radius fractures were included in this retrospective study. Univariate analysis and multivariate logistic regression analysis were performed to predict risk factors.ResultsUnivariate analysis showed that sex, volar tilt, the Soong grade, the plate-to-critical line distance (PCLD), the plate-to-volar rim distance (PVRD), and the time of plate removal were significantly associated with FPL attrition or rupture. Multivariate logistic regression analysis demonstrated that decreased volar tilt, Soong grade 2, PCLD of >2 mm, PVRD of <3 mm, and plate removal at ≥1 year were the risk factors significantly associated with FPL attrition or rupture.ConclusionsReduced volar tilt, Soong grade 2, PCLD of >2 mm, and PVRD of <3 mm appear to be risk factors that are significantly associated with FPL attrition or rupture. The findings of this study also suggest that the risk of tendon rupture is lower if a Soong grade 2 plate is removed, the PCLD is >2 mm, the PVRD is <3 mm, or reduced volar tilt is achieved earlier (at <1 year).

Proximal row carpectomy combined with primary flexor pollicis longus tenorrhaphy: An effective treatment alternative for a rare case of flexor pollicis longus rupture due to scaphoid nonunion advanced collapse

This study describes a case of flexor pollicis longus rupture resulting from long-term scaphoid nonunion advanced collapse. The tendon rupture mechanism was attrition due to sharp bone protuberances from the scaphoid in the carpal tunnel. Although this extremely rare complication has already been reported in the literature, our study is original in showing that proximal row carpectomy with consequent wrist shortening allowed primary tendon repair without transferring the flexor digitorum superficialis tendon of the ring finger or grafting the palmaris longus tendon, which besides using two-level suturing, interposes a non-vascularized tissue.

The outcome of untreated flexor pollicis longus rupture in patients with rheumatoid arthritis

The aim of the study was to assess the natural history of untreated flexor pollicis longus (FPL) tendon rupture in patients with rheumatoid arthritis (RA). We reviewed a cohort of patients to assess the long-term effect of conservative management. We reviewed nine of 11 consecutive patients. We assessed objective outcomes including ranges of motion and strength and subjective outcomes including pain and function scores. We assessed seven women and two men. They had a mean age of 67 (range 48–82) years. Six of the nine patients had no more symptoms on the side of their FPL rupture than in the other thumb. Two were mildly more symptomatic and one much more symptomatic. Late thumb hyperextension did not appear to be a symptomatic problem. We recommend waiting at least 6 weeks before considering surgical reconstruction in patients who have an FPL rupture secondary to RA. The majority will recover so well that they may not choose reconstructive surgery.Level of evidence: IV

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

Volar locking plates not touching the flexor pollicis longus tendon appear as prominences on radiographs: a cadaver study

BackgroundPlate protrusion is a risk factor for flexor pollicis longus (FPL) rupture following volar locking plate (VLP) surgery. However, plate prominence on follow-up radiographs is common. We hypothesised that a VLP that does not touch the FPL tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs.Materials and methodsWe studied six current designs of widely used plates in formalin-fixed cadavers. Each plate was placed in six cadavers. We analysed 36 different plate–cadaver combinations. The main aim of plate fixation was to position the plate in the most distal position without FPL tendon contact. Radiographs were obtained using fluoroscopy. We evaluated plate prominence from the volar ridge according to the Soong grading system.ResultsSoong grades 0 (plate did not extend beyond volar ridge), 1 (plate protruded beyond volar ridge) and 2 (plate directly on or located beyond the volar ridge) were observed in 23 (63.9%), 9 (25.0%) and 4 (11.1%) cadavers, respectively. VariAx, DVR and VALCP showed grade 1 prominence, whereas Acu-Loc2, HYBRIX and MODE showed grade 2 prominence.ConclusionsImplant protrusion was observed in 36% of plate–cadaver combinations, even if the plate did not touch the FPL. Estimating the risk of FPL rupture using lateral radiographs alone is likely insufficient. Our findings can be applied to accurately identify the presence of implant prominence following VLP surgery.

Incidence of Flexor Pollicis Longus Complications Following Volar Locking Plate Fixation of Distal Radius Fractures.

Background: Distal radius fractures are among the most common orthopedic injuries presenting to emergency departments. The complications of distal radius open reduction and internal fixation (ORIF) range from paresthesia to tendon ruptures. The Soong grading system was designed to evaluate volar plate position to predict postoperative flexor pollicis longus (FPL) ruptures. This study evaluates post-distal radius volar fixation FPL ruptures and other postoperative complication rates relative to Soong grade, surgical training, and plate design. Methods: A retrospective chart review was conducted to assess recorded complications after distal radius ORIF. Soong grade was determined on postoperative radiographs. Other demographic features, along with the surgeon fellowship training and plate design, were noted. Analysis was performed via t test, χ2 test, rank sum test, and Fisher exact test. Results: A total of 522 patients met inclusion criteria. Flexor tenosynovitis was the most commonly recorded complication (21% of total complications). No FPL ruptures were recorded. Soong grades between patients with and without complications were not significantly different. Soong grades between patients with flexor tenosynovitis and other complications were not significantly different. Flexor tenosynovitis had higher odds of occurring compared with other complications when the surgeon was hand-trained or when the plate type was designed by Acumed. These higher odds were not maintained under multivariate regression analysis. Conclusion: Lack of FPL ruptures in this large series may reflect improved plate technology and increased awareness. The association between flexor tenosynovitis and hand fellowship-trained surgeons may be associated with more complex cases being referred to specialists.

Ultrasonographic movement of the flexor pollicis longus tendon before and after removal of a volar plate for the distal radius fracture.

The purpose of this study was to compare the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions before and after removal of a volar plate in patients with distal radius fractures using transverse ultrasound and to evaluate the kinematic effects on the FPL by the removal. Twenty-five patients with distal radius fracture were evaluated quantitatively by transverse ultrasound using coordinates for the movement of the FPL on the distal radius during wrist and finger motions before and after the plate removal. At all wrist positions, during finger motion, the FPL moved significantly more palmarly away from the radius after plate removal compared to before. However, the FPL was still situated more dorsoulnarly compared with unaffected side. Moreover, the FPL moved significantly most dorsally both before and after removal at the wrist dorsal flexion position with finger flexion. These findings suggested that any adhesion between the FPL and the pronator quadratus (PQ) muscle was released by removing the plate and that the FPL would approach original tendon movement. Additionally, it is speculated that any remaining atrophy and fibrosis of the PQ may be the reason for more dorsoulnar location of the FPL in the affected side compared with the unaffected one. This ultrasound evaluation may be useful in further understanding the FPL kinematics on the distal radius, and in appropriate treatment of the distal radius fracture with plate fixation for preventing FPL rupture.

Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review

Tendon-related complications after plate fixation of distal radius fractures can cause significant morbidity in the patient. This retrospective systematic review aims to report and compare the current rate of tendon rupture and tenosynovitis complicating the operative management of distal radius fractures. A systematic literature search was performed to identify relevant articles reporting tendon complications after operative management of distal radius fractures. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and the Cochrane Library-starting from the establishment of each database to February of 2016. A total of 56 studies met the inclusion criteria, including 6278 patients. Overall tendon-related adverse events were reported in 420 patients (6.8 percent). The incidence of tendon rupture was 1.5 percent with volar plates and 1.7 percent with dorsal plates. The incidence of tenosynovitis was 4.5 percent with volar plates and 7.5 percent with dorsal plates. Individual tendon complications were reported with volar and dorsal fixation, respectively: extensor pollicis longus tenosynovitis (0.3 percent and 1.1 percent), extensor pollicis longus rupture (0.8 percent and 0.3 percent), flexor pollicis longus tenosynovitis (1.3 percent and 0 percent), flexor pollicis longus rupture (0.6 percent and 0.2 percent), flexor digitorum profundus/flexor digitorum superficialis tenosynovitis (1.2 percent and 1.3 percent), flexor digitorum profundus/flexor digitorum superficialis rupture (0.1 percent and 0 percent), extensor digitorum communis tenosynovitis (1.7 percent and 5.9 percent), and extensor digitorum communis rupture (0.05 percent and 1.3 percent). This systematic review provides an update on the literature regarding tendon-related complications in the management of distal radius fractures.

Tendon Rupture After Volar Locking Plate Fixation of Distal Radius Fractures

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.

Transverse ultrasound assessment of the flexor pollicis longus tendon movement on the distal radius during wrist and finger motion in distal radius fracture with volar plating.

We investigated the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions using transverse ultrasound in patients with distal radius fractures who underwent volar locking plating. Both wrists of 39 distal radius fracture patients with volar locking plate fixation were evaluated by transverse ultrasound to examine the location of the FPL tendon on the distal radius at varied wrist positions in full finger extension and flexion. At all wrist positions during finger motion, the FPL tendon shifted significantly more dorsally on the affected side than on the unaffected side. Additionally, at the wrist dorsal flexion position with finger flexion, the FPL tendon moved significantly the most dorsally, and the distance between the FPL tendon and the plate or the radius was the smallest among all wrist positions during finger motion. This study showed that the wrist dorsal flexion position with finger flexion could be the appropriate position to examine FPL tendon irritation after plating. Moreover, it would be effective for preventing FPL rupture to cover the FPL transverse gliding area approximately 10mm radial to the vertex of the palmar bony prominence of the distal radius with the pronator quadratus and the intermediate fibrous zone.

The role of fracture reduction and plate position in the aetiology of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures.

Flexor pollicis longus (FPL) rupture has been described as complication following volar plating for distal radius fractures. It has been hypothesised that this is due to plate prominence. The aim of the study was to investigate the relationship between sub-optimal plate position and fracture reduction on plate prominence. Plate prominence was measured in two experimental models. In the first, the effect of plate position was investigated using 18 fresh frozen cadavers with prominence being measured using a micrometer. In the second study, the effect of fracture reduction on plate prominence was investigated using similar methodology with simulated mal-reductions on dry bone models. The results of the first study showed a significant increase in lift-off for three plates (DVR, Synthes Universal and Acu-Loc), if the plates were moved distally or proximally from the anatomical position. Similar increases in prominence were also seen with rotational mal-positions. The results of the second study showed a statistically significant effect on plate prominence for even a 5° mal-reduction (p = 0.001) with worsening lift-off with increasing mal-reduction. These changes are significantly different from baseline and also significantly different to the lift-off recorded with mal-reductions 5° better and worse. Mal-reductions also necessitate more proximal placement of the plate to avoid screw penetration of the articular surface, and each 5° increment is significantly different from baseline. The results show a statistically and clinically significant effect of both plate position and fracture reduction on plate prominence and support the theory that both contribute to the aetiology of post-operative FPL rupture.

Free tendon grafts in elder patients, a case report of repair of flexor pollicis longus tendon with a free palmaris longus graft in an 89-year-old woman

Flexor tendon rupture is a potential complication after volar plating of distal radius fracture. Palliative procedures such as tenodesis and arthrodesis are usually employed in elder patients with imperfect results. We report a case of delayed flexor pollicis longus rupture seven years after volar plating of a distal radius fracture occurring in an 89-year-old woman. The repair with a free tendon graft of palmaris longus was successful in terms of strength and range of motion. Free tendon grafts should not be limited to younger patients and could be used in elder patients after careful selection.

The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures – A case control study

Background and aimVolar plating of distal radius fractures is one of the common procedures performed in trauma surgery. Flexor pollicis longus (FPL) rupture has been described as complication following volar plating of distal radius fractures.The aim of our study was to investigate the possible relation between parameters measured on post-operative radiographs and the occurrence of FPL ruptures. Materials and methodsThis was a case control study. The post-operative radiographs of 11 FPL rupture, and 22 non-FPL rupture patients were reviewed with respect to fracture reduction and plate position and the various parameters were calculated by five independent people.Logistic regression was used to examine the importance of the variables. ResultsWe identified two significant factors to predict FPL rupture after volar plating of distal radial fractures. These were radial tilt and plate distance from the joint line. The odds ratio of ruptures was 0.74 (95% CI 0.57–0.95) for every degree of radial tilt <25° and 0.50 (95% CI 0.28–0.88) for every millimetre that the distal end of the plate was away from the volar lip of the distal radius at the wrist joint. ConclusionPost-operative radiographs could help us predict FPL rupture after distal radius volar plating. The findings also highlight the need for good fracture reduction and thoughtful placement of the volar plate intraoperatively to minimise the risk of FPL tendon rupture.