Complications of Distal Radius Fractures Treated by Volar Locking Plate Fixation

Satake, Hiroshi; Hanaka, Naomi; Honma, Ryusuke; Watanabe, Tadayoshi; Inoue, Shigeru; Kanauchi, Yumiko; Kato, Yoshihiro; Nakajima, Taku; Sato, Daisuke; Eto, Jun; Maruyama, Masahiro; Naganuma, Yasushi; Sasaki, Junya; Toyono, Shuji; Harada, Mikio; Ishigaki, Daisuke; Takahara, Masatoshi; Takagi, Michiaki

doi:10.3928/01477447-20160517-05

Cited by 33 publications

(27 citation statements)

References 18 publications

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“…Although volar plating is the most popular surgical modality [9], complications, such as carpal tunnel syndrome and rupture of tendon(s), are often reported [10]. Thus, research continues for alternative surgical modalities to volar plating, such as the notional one (injectable bioresorbable polymer fixator) presented in the present work.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, some have referred to this system as becoming "the treatment of choice" in cases where surgical treatment is deemed appropriate [9]. However, complications after fixation with this system, such as rupture of tendon(s), and its shortcomings, such as delay in wound healing, are well known [10]. Thus, there is scope for development of a new generation of innovative modalities as an alternative to the volar locking plate system.…”

Section: Introductionmentioning

confidence: 99%

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Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Zysk¹,

Lewis²

2017

WJET

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Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system ("fixator") versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads. For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon) but not by modulus of elasticity assigned to the polymer; 2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model; and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Zysk¹,

Lewis²

2017

WJET

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“…Currently, a number of volar plate options exist, including fixed-angle and variable-angle locking plates, with their own potential complication profiles: Rates of nerve complications range from 0.4-14%, with CTS being the most commonly reported type. (38,48,51,74,94,99,102,103) One large multi-institutional retrospective study by Satake et al identified 694 patients treated by volar locking plate, of which only 4 cases of tendon rupture (0.6%) were reported, while 18 cases of CTS (2.6%) and 3 cases of CRPS (0.4%) were reported, indicating a greater incidence of nerve complications than tendon complications. (93) Reported rates of hardware-related complications range from 0-7%, with malunion being the most frequent.…”

Section: Volar Plate Specific Complicationsmentioning

confidence: 99%

“…(93) Reported rates of hardware-related complications range from 0-7%, with malunion being the most frequent. (38,48,51,74,94,99,102,103) Some studies have also directly compared the outcomes of volar non-locking and volar locking plates. One study by Obert et al retrospectively compared 31 patients treated by volar plating with non-locking screws to 121 patients treated by volar plating with locking screws and found no significant difference in the overall complication rates of the two groups (16.1% vs.…”

Section: Volar Plate Specific Complicationsmentioning

confidence: 99%

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures

Alter

Ilyas²

2018

JBJS Rev

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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)

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“…Distal radius fractures remain one of the most common orthopedic injuries, accounting for 8-17% of all extremity fractures, and open reduction and internal fixation with a volar locking plate has become the gold standard treatment to correct them [1][2][3][4]. However, several complications associated with volar locking plates have also become better defined [2,5,6]. Flexor pollicis longus (FPL) tendon rupture is one of the major complications, having an incidence rate of 0.2-12% [2,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

et al. 2018

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Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.

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Complications of Distal Radius Fractures Treated by Volar Locking Plate Fixation

Cited by 33 publications

References 18 publications

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

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