Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures

Abstract

Distal radius fractures are among the most common orthopaedic injuries. Of 590,193 fractures of the upper extremity documented in the United States in 2009, distal radius fractures were the most common.(1) Additionally, they comprise one-sixth of all fractures seen in the emergency room.(2) In recent years, incidence of this already common fracture has continued to increase in pediatric, adult, and elderly populations alike.(3) However, despite the high incidence of distal radius fractures, consensus regarding optimal treatment strategy still does not exist. Current treatment options include closed reduction, closed reduction with percutaneous pinning, intramedullary fixation, external fixation, and various open reduction and internal fixation strategies.(4, 5) Of these, open reduction and internal fixation with plates has seen a steady increase in use over the past two decades due to purported faster functional recovery and better radiographic alignment,(6) although better radiographic outcome does not necessarily translate to better long-term functional outcome in all groups.(7, 8) During this time there has been a simultaneous decreased use of dorsal plating due to concerns for extensor tendon irritation,(9) and a concomitant increase in the use of volar locked plating of distal radius fractures, particularly among newer surgeons.(10) Volar locked plating of distal radius fractures has grown in popularity for several reasons including a consistent and reproducible surgical approach, broad range of fractures patterns that a volar plate can treat, and a reasonable complication profile compared to other operative fixation methods with a reportedly lesser rate of tendon injury.(11) However, there remain fractures that should not be treated with volar plating, including highly comminuted fractures which may be better managed with wrist arthrodesis.(12, 13) Additionally, the exact incidence and pattern of complications from volar locking plates for distal radius fractures are not well understood. 3 EVOLUTION OF VOLAR LOCKING PLATE TECHNOLOGY Volar plating of distal radius fractures has been a surgical option since the introduction of AO principles of fracture fixation. Initially, volar plates were primarily indicated for buttress reduction and fixation of volar shear fractures, aka volar Barton's fractures.(14, 15) (FIGURE 1)

Safety and Reliability of Carbon-Peek Plate for the Treatment of Distal Radius Fractures: A Review of the Literature

“…We might hypothesize that this easier implant breakage might be linked to significant weakness to deformation and lower load to failure of CFR-PEEK compared to traditional plates. [32][33][34][35] We found no significant differences in the other papers analyzed compared to the more widely used devices.…”

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

“…Among the multitude of therapeutic options after distal radius fractures, palmar locking plate fixation has increased in importance and is currently a common standard procedure even for elderly patients [13]. The advantage of palmar plating is the good soft-tissue coverage and the lower complication rate [19]. At the same time, this therapy also means that the PQ is dissected longitudinally to expose the fracture.…”

Is Unicortical Locking Screw Placement Effective For The Torsional Loads in the Distal Radius Fractures? : Biomechanical Study in Cadaver

“…Potential injuries to extensor tendon may either occur during drilling or postoperatively due to irritation caused by the screw's protrusion into the dorsal surface [7][8][9]. In order to overcome the latter, unicortical delivery of the distal screws has been suggested.…”