Flexor Pollicis Longus Tendon Ruptures after Palmar Plate Fixation of Fractures of the Distal Radius

Casaletto, John A.; Machin, David; Leung, Robert; Brown, D. J.

doi:10.1177/1753193408100964

Cited by 84 publications

(68 citation statements)

References 16 publications

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“…This hypothesis has also been put forward by other authors [2,3,9,13]. The results of this study seem to support this argument with both statistically and clinically (mechanically) significant increases in lift-off, our measure of prominence, seen with both sub-optimal plate position and sub-optimal fracture reduction.…”

Section: Discussionsupporting

confidence: 89%

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

Selvan

Machin

Perry

et al. 2015

Hand (New York, N,Y.)

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Background 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. Methods 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. Results 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. Conclusions 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.

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Section: Discussionsupporting

confidence: 89%

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

Selvan

Machin

Perry

et al. 2015

Hand (New York, N,Y.)

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“…We have noted an incidence of complications of 8 %, reflecting a low overall complication rate owing to a lack of flexor tendon injuries and a lower rate of CRPS than other studies. Flexor tendon injury following DRF fixation has been reported by various authors [25][26][27] with prominence of the plate and poor implant placement implicated in the aetiology of this complication [28][29][30]. In the present series we have noted an incidence of flexor tendon injury of 0 % at a mean follow up time of 30 months and a minimum of 12.…”

Section: Discussionsupporting

confidence: 55%

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2016

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Distal radius fractures are increasingly treated by internal fixation, but there have been relatively few studies relating to functional outcome at 12 months or more. The aim of this study was to ascertain the patient reported function of the wrist at a minimum of 12 months following fixation of a distal radius fracture, the time taken to return to work, and the complication rate. We conducted a retrospective review of 187 consecutive patients treated by a specialist hand and wrist trauma team at a tertiary referral unit over a 5 year period. Mean age was 57.3 years (range 16-93). Median time to surgery was 4 days (interquartile range 2-9). Median follow up was 31 months (interquartile range 23-41 months). The median PRWE score was 3; (range 0-83). There was no difference in outcome in patients who had surgery delayed by greater than 2 weeks (p>0.05). The median time to return to work was 5 weeks (interquartile range 1-8 weeks). There were 15 complications (8 %) including 3 tendon injuries. We have demonstrated an early return to work in patients who were employed, a low complication rate, and highly favourable functional outcomes at a mean of 30 months postoperatively. We recommend the use of the DVR plate and involvement of a dedicated hand and wrist trauma team for treatment of unstable fractures of the distal radius.

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“…7,11,19,24,28 In the current study, the intraoperative finding of flexor tendon attrition occurred in 12 patients (10%), which was somewhat higher than the frequencies described in some previous studies. This discrepancy may be explained by the difference between the attrition measured in this investigation and the complete rupture evaluated in others; we defined attrition as an intraoperative finding of incomplete tendon rupture.…”

Section: Discussioncontrasting

confidence: 72%

Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study

Yamazaki

Uchiyama

Komatsu

et al. 2015

The Journal of Hand Surgery

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Flexor Pollicis Longus Tendon Ruptures after Palmar Plate Fixation of Fractures of the Distal Radius

Cited by 84 publications

References 16 publications

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

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

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study

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