Plating Of Distal Radius Fractures Research Articles

Risk Factors of Flexor Tendon Rupture After ORIF of Distal Radius Fracture.

To analyze the risk factors associated with postoperative flexor tendon rupture, after a volar plate fixation of distal radius fractures. Retrospective observational case-control study. Tertiary Care University Hospital in the Republic of Korea (2009-2020). Sixteen referred patients were treated for flexor tendon rupture, following previously performed volar plating of distal radius fractures at other institutions. 16 patients were randomly selected from our database as controls, and were matched based on the Soong grade of the case group. Not applicable. Radial tilt and radial height were measured on anteroposterior radiographs. The volar tilt, tear drop angle, carpal translation, and Soong grade were measured in a lateral view. Quantitative measurements of the volar tilt, carpal translation, and tear drop angle were positively correlated with the flexor tendon rupture. The mean volar tilt and tear drop angle in the tendon rupture group were significantly smaller than those in the control group. The mean carpal translation in the tendon rupture group was significantly greater than that in the control group. This study demonstrated that volar tilt, carpal translation, and tear drop angle are significant risk factors for flexor tendon rupture, especially for plates placed at Soong grade 1 or 2. We suggest that the potential for tendon rupture because of incomplete reduction of the distal radius fracture along with implant prominence volar to the watershed line aggravates flexor tendon irritation at the distal edge of the plate because of distorted flexor tendon paths. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature.

Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.

Complications After Volar Locking Plate Fixation of Distal Radius Fractures: A Retrospective Study of 822 Patients

With the current routine use of volar locking plates as the preferred surgical treatment option for distal radius fractures, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications. We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years. We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n= 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n= 18) of the patients; and carpal tunnel syndrome, observed in 1.9% (n= 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications. In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications. Prognostic IV.

Outcome Of The Distal Radius Fractures Managed With Across Wrist External Fixator Vs Buttress Plates.

Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius. A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient's functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21. There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population. Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.

Dorsal Plating for Distal Radius Fractures

Aim: This study aims to evaluate the radiological and functional outcome and also to assess the complication rates associated with dorsal plating of the distal radius with low profile plates. Materials and Methods: A single-centered, prospective study on 21 patients with unstable dorsally displaced distal radius fractures between March 2019 and March 2022. We used low-profile dorsal locking plates (Arthrex) for all the cases. The functional outcome was measured using VAS score, disabilities of the arm, shoulder, and hand (DASH) questionnaire, and Gartland and Werley Score. The arc of motion and grip strength were measured on the operated wrist and compared with the contralateral wrist. We also recorded the associated postoperative complications. Results: The study group contains 11 men and 10 women with a mean age of 49 years. The mean duration of follow-up was 18 months (range 12–32). There were no cases of malunion, extensor tendon irritation, infection, neuropathy, or implant failure. The radiological union was seen in all cases. The range of motion and grip strength of the operated wrist was found to be more than 95% of that of the contralateral wrist. The mean VAS score was 0.85, DASH score 4.75 ± 0.97, and Gartland and Werley score showed excellent outcomes for all 21 cases. The experimental demonstration on bone models showed poor mechanical stability by volar plates on shear-type fractures. Conclusion: The newer low-profile dorsal locking plate provides mechanical and structural stability to the dorsally displaced fractures, even in those with poor bone stock, and is associated with negligible soft-tissue complications. We strongly recommend using dorsal plates for all dorsally displaced fractures which are distal to or at the level of the watershed line.

Evaluation of Ulnar Setting of Volar Locking Plates for Distal Radius Fractures Using Modified Skyline View

Volar lunate facet fragments in distal radius fractures are located at the center of the load in the wrist joint and, therefore, should be properly supported by the distal ulnar setting of volar locking plates to obtain better postoperative outcomes. This study evaluated the usefulness of the modified skyline view (MSV) in intraoperative fluoroscopy for the ulnar setting of volar locking plates by comparing it with that of the anteroposterior view (APV). Sixty-five patients with distal radius fractures who underwent open reduction and plate fixation as well as follow-up intraoperative fluoroscopy and postoperative computed tomography (CT) at our institution between April 2019 and March 2022 were included. The distance between the ulnar edge of the plate and the distal radius (d-value) was measured retrospectively using intraoperative fluoroscopy (distance measured from MSV and distance measured from APV) or postoperative CT (distance measured using postoperative CT). The distance measured from MSV and that measured from APV were compared with those measured using CT as the true values. Each measurement was performed twice by 2 examiners at an interval of 1 month. The comparison scores were evaluated using the intraclass correlation coefficient. The distance measured from MSV showed a difference of 0.6 ± 0.5 mm from that measured using CT, which was significantly smaller than that measured from APV (1.2 ± 0.9 mm; P < .001). Neither postoperative volar subluxation nor dislocation of bone fragments was found during the study period. Both intraclass correlation coefficient (1,1) and intraclass correlation coefficient (2,1) reliabilities were substantial to almost perfect. Modified skyline view is an effective and versatile imaging method for estimating the ulnar setting of volar locking plates; it provides measurements more similar to those provided by postoperative CT compared with APV. The use of MSV may reduce postoperative complications, such as volar subluxation and dislocation of bone fragments, especially in cases with volar lunate facet fragments in which the ulnar setting of the plate is significant. Diagnostic III.

Minimally Invasive Fixation with Dorsal Suspension Button and Volar Plate in Distal Radius Fractures with Dorsal Die Punch Fragments: A Preliminary Study.

Objective The objective of the study is to analyze the clinical and radiological results obtained using a minimally invasive fixation technique with a volar locking plate and a suspension system with a dorsal button in distal articular radius fractures with dorsal comminution. Materials and Methods Six patients with distal radius fractures, between 19 and 68 years of age, were included in the study. Mean follow-up was of 15 weeks. Range of motion (ROM) in flexion, extension, radial deviation, ulnar deviation, pronation, supination, the strength in kilograms, and values on the Visual Analog Scale (VAS), Disabilities of Arm, Shoulder and Hand (DASH), and Mayo Wrist Score (MWS) scales were evaluated at 4, 8, and 12 weeks postoperative. Correction of anteroposterior diameter of the radius and concordance between postoperative anteroposterior diameter and the contralateral wrist diameter were evaluated radiologically. Results The following mean values were obtained at 12 weeks postoperative: ROM in flexion: 40.5°, ROM in extension: 49.5°, ROM in radial deviation: 24.5°, ROM in ulnar deviation: 15°, ROM in pronation: 87°, ROM in supination: 89°, strength: 37.5 kg, pain in VAS scale: 2 points, DASH: 54.5 points, and MWS: 67.5 points. At 12 weeks postoperative, the mean correction of anteroposterior diameter was 0.49 mm. The anteroposterior diameter and that of the contralateral wrist were strongly correlated. Conclusion Fixation with the volar locking plate and dorsal suspension button could be considered an alternative to dorsal plate fixation for treatment of distal radius fractures with comminution or associated dorsal die punch fragments.

Evaluation of sparing the pronator quadratus for volar plating of distal radius fractures: a retrospective clinical study

BackgroundThe most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.AimThe objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.MethodsSeventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated.ResultsAll patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.ConclusionThe modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment \u2013 a biomechanical study

Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.

Results of Stellar D plate for distal radius fracture

Results of Stellar D plate for distal radius fracture

IS VOLAR PLATING IN DISTAL RADIUS FRACTURES SAFE REGARDING PRONATOR QUADRATUS?

ABSTRACTObjective:This study aimed to investigate whether isokinetic strength decrease significantly after using volar plating for distal radius fractures and evaluate the pronator quadratus muscle regarding atrophy.Methods:This study took place between 2011 and 2015 and included 18 distal radius fracture patients (group 1) who were treated via volar plating at least one year prior and 14 healthy controls (group 2). All participants were tested isokinetically. Grip strength, radiological evaluation, wrist range of motion, disabilities of the arm, shoulder, and hand and visual analog scale scores were assessed for clinical and functional outcomes. Ultrasonography evaluated the pronator quadratus muscle thicknesses.Results:The peak supination torque (PT) and supination work per repetition (WPT) strength values significantly decreased (p:0.039, p:0.025, respectively). Although we determined an 11% pronation PT deficit and a 19% pronation WPT deficit, neither were significant. In group 1, the pronator quadratus muscle thickness decreased 5.9% ± 13.3 in the radial area and 9.7% ± 10.5 in the interosseous area according with ultrasonography; these results were not statistically significant compared to group 2. All clinical and functional outcomes were not statistically significant between the groups.Conclusion:The use of volar plating after distal radius fractures is a safe method regarding isokinetic strength and pronator quadratus muscle atrophy. Level of evidence III; Retrospective case-control study .

Mechanical Comparison of a Novel Hybrid and Commercial Dorsal Double Plating for Distal Radius Fracture: In Vitro Fatigue Four-Point Bending and Biomechanical Testing.

This study compares the absolute and relative stabilities of a novel hybrid dorsal double plating (HDDP) to the often-used dorsal double plating (DDP) under distal radius fracture. The “Y” shape profile with 1.6 mm HDDP thickness was obtained by combining weighted topology optimization and finite element (FE) analysis and fabricated using Ti6Al4V alloy to perform the experimental tests. Static and fatigue four-point bending testing for HDDP and straight L-plate DDP was carried out to obtain the corresponding proof load, strength, and stiffness and the endurance limit (passed at 1 × 106 load cycles) based on the ASTM F382 testing protocol. Biomechanical fatigue tests were performed for HDDP and commercial DDP systems fixed on the composite Sawbone under physiological loads with axial loading, bending, and torsion to understand the relative stability in a standardized AO OTA 2R3A3.1 fracture model. The static four-point bending results showed that the corresponding average proof load values for HDDP and DDPs were 109.22 N and 47.36 N, that the bending strengths were 1911.29 N/mm and 1183.93 N/mm, and that the bending stiffnesses were 42.85 N/mm and 4.85 N/mm, respectively. The proof load, bending strength and bending stiffness of the HDDPs were all significantly higher than those of DDPs. The HDDP failure patterns were found around the fourth locking screw hole from the proximal site, while slight plate bending deformations without breaks were found for DDP. The endurance limit was 76.50 N (equal to torque 1338.75 N/mm) for HDDP and 37.89 N (equal to torque 947.20 N/mm) for DDP. The biomechanical fatigue test indicated that displacements under axial load, bending, and torsion showed no significant differences between the HDDP and DDP groups. This study concluded that the mechanical strength and endurance limit of the HDDP was superior to a commercial DDP straight plate in the four-point bending test. The stabilities on the artificial radius fractured system were equivalent for novel HDDP and commercial DDP under physiological loads in biomechanical fatigue tests.

Volar plating for distal radius fractures: A prospective clinical study

Distal radius fractures are one of the most common type of fractures. They occur at the end of the radius bone near the wrist joint. An unstable distal radius fracture has been defined as a fracture that after an attempt at closed reduction demonstrates radiographic evidence of more than 15 of angulation in any plane, articular step off of more than 2 mm and/or radial shortening of more than 2 mm. Locked volar plating is the most common surgical procedure to treat distal radius fractures. The extended flexor carpi radial is (FCR) approach/Henry approach continues to be an excellent method for treating distal radius fracture surgically. Volar plating offers biomechanically stable fixation, allows early rehabilitation and enables treatment of the comminuted or osteopenia bone. Aim of the study is to investigate correlation between radiological and clinical outcome in patients of displaced distal radius fractures with volar intraarticular component stabilized by volar locking plate. Material and methods: Total 25 patients of distal radius fractures with ventral intraarticular component were studied in SB Medical College, Hazaribag from August 2019 to September 2021.12 male patients and 13 female patients were present. The age varied from 28-75 years (mean age 58 years). The cases were followed up clinically and radiologically with a mean follow up of 18 months. Outcome was assessed using pain, range of motion (ROM) and grip strength parameters. The immediate post-operative and final checkup radiography were scrutinized for alignment and intra-articular step off. No significant differences could be found between an unacceptable (>2mm) and acceptable (

Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases.

Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III–V.

Palmar plating of distal radius fractures : 3-year follow-up with titanium and PEEK plates give similar outcomes

A variety of different plate designs and materials are available to treat distal radius fractures. This study evaluates clinical results with a carbon fibre- reinforced (CFR)-polyether ether ketone (PEEK) plate in comparison to a standard titanium plate. Thirty-one distal radius fractures were included in this randomised controlled trial. Five fractures were classified as type A, 6 as type B and 20 as type C, in accordance with the AO classification. Patients were randomly allocated into two groups : 15 patients for titanium palmar plating (TPP) and 16 patients for PEEK palmar plating (PPP). Follow-up examinations were set at 2 weeks, 6 weeks, 3 months, 6 months and 3 years postop. In terms of wrist range of motion, radiological evaluation (alignment and fracture healing), DASH score (Disabilities of Arm, Shoulder and Hand), and VAS (visual analogue scale), no statistically significant differences were detected between the two groups, at all follow-up intervals. PEEK palmar plating and titanium plates give equivalent clinical and radiological outcomes up to 3 years follow-up.

Comparison of Intramedullary Nail and Volar Locking Plate for Distal Radius Fractures: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Operative intervention with a volar locking plate (VLP) is currently the gold standard for the fixation of distal radius fractures. Intramedullary nailing (IMN) of the distal radius is a novel technique that aims to reduce soft tissue complications due to a smaller surgical incision while maintaining the benefits of a rigid fracture fixation. The aim of this systematic review and meta-analysis was to investigate the functional, clinical, and radiological outcomes of all published randomised controlled trials (RCTs) comparing patient outcomes of VLP and IMN in distal radius fracture fixation. Three databases (Ovid MEDLINE, EMBASE, and Cochrane Library) were searched in July 2021. The inclusion criteria were RCTs comparing fixation of extra-articular or simple intra-articular distal radius with VLP or IMN and availability of full text in English. Children under the age of 18 were excluded. Seven trials with a total of 398 patients were included in this meta-analysis. The meta-analysis showed that there were improved short-term clinical outcomes favouring IMN, although there were no significant differences in terms of functional, radiological, and long-term clinical outcomes. Analysis showed that outcomes of IMN are comparable with VLP for fixation of extra-articular and simple intra-articular distal radius fractures. However, these results should be interpreted with caution due to the small sample size. We recommend that further high-quality trials are required to establish the role of IMN in 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).

Bridge Plate Fixation of Distal Radius Fractures: Indications, Techniques, and Outcomes.

Distal radius fractures are among the most commonly encountered injuries treated by orthopedic surgeons. The incidence of distal radius fractures appears to be on the rise. Although this injury is usually treated nonoperatively, surgical management is often indicated and involves several options, including percutaneous pinning, fragment-specific fixation, volar/dorsal/radial locked plating, intramedullary fixation, and external fixation. More recently, dorsal spanning bridge plating has been introduced for certain fracture patterns and patient circumstances. This article reviews the indications, surgical techniques, outcomes, and potential complications associated with bridge plating of distal radius fractures. The authors believe that this article will familiarize surgeons with an additional surgical technique that can be used to treat complex presentations of a common orthopedic injury. [Orthopedics. 2021;44(4):e620-e625.].

Flexor tendon rupture after volar plating of distal radius fracture: A systematic review of the literature

Flexor tendon rupture after volar plate fixation of distal radius fracture (DRF) is rare. There is no consensus as to how to prevent them. The aim of our study was to identify the pathological mechanisms, and to establish the clinical and epidemiological profile of patients suffering from this complication. We carried out a systematic review using the PubMed, Scopus and Cochrane databases. Studies were included if they described complete or partial flexor tendon rupture following volar plate fixation of DRF. Forty-six 46 were included, for a total of 145 patients were reported: 138 from the literature, and 7 from our personal experience. Etiology was usually mechanical, by impingement with either the plate or protruding screws. Plate impingement was due to positioning beyond the watershed line, consolidation with posterior tilt, plate thickness, or low palmar cortical angle. Mean patient age was 62.4 years (range, 23–89 years). Median postoperative interval was 8 months (range, 3–120 months). Flexor pollicis longus was the most frequently injured tendon. The plate should be positioned proximally to the watershed line if possible, to ensure good initial reduction. Hardware should be removed 4 months after surgery if the plate is causing impingement according to the Soong criteria or if signs of tenosynovitis appear.