Impact of Design on Force between Flexor Tendons and Distal Radius Volar Plates

Abstract

Background Flexor tendon injury is a rare but serious complication of distal radius volar plating. Purpose This study aims to determine whether the design of distal radius volar plates impacts the amount of force exerted on the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons when the plates are placed proximal and distal to the watershed line. Methods Three commercially available plates were applied to 10 fresh, matched-pair upper extremity specimens. Cyclical loading was applied to the tendons, and the force generated between tendon and plate was measured. Linear mixed effect models were used to evaluate differences in maximum and mean forces by plate position, plate design, and the interaction between position and design. Results Forces on the tendons differed significantly by position but not plate design. For the FPL tendon, the average maximum force with a plate in Soong's grade 2 was 4.50 (95% confidence interval [CI]: 2.8–7.3) times higher than when the plate was in a Soong's grade 0 placement, and 4.63 (95% CI: 2.82–7.61) times higher for the FDP tendon. While not statistically significant, lower observed force values with thinner plates when plates were placed distal to the watershed line suggest that that plate thickness could also be a critical plate characteristic for distally placed plates. Conclusion Despite differences in plate design, the main determinant of plate prominence and therefore flexor tendon injury potential is placement in relation to the watershed line. Clinical Relevance This study may help to guide surgeon implant selection and volar plate design.

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

“…Hinchcliff et al. 37 found that the volar plate design did not significantly impact either the mean or median force between the plate and the flexor tendons. However, Limthongthang et al.…”

“…Thus, further research is needed. Hinchcliff et al 37 found that the volar plate design did not significantly impact either the mean or median force between the plate and the flexor tendons. However, Limthongthang et al 11 found that a plate with a Y-shaped design (the FPL plate), in which the bridging segment of the plate between the radial and intermediate columns had been removed, had a significantly smaller contact area between the plate and the FPL relative to other plates.…”