Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures

Abstract

The purpose of this study was to evaluate flexor tendon injuries following palmar plating of distal radial fractures relative to the Soong grade. This retrospective cohort study included 113 patients who underwent palmar plate removal after a distal radial fracture between 2010 and 2016. In 13 patients, a greater than 50% injury of the flexor pollicis longus tendon was observed. Of these, nine patients were classified as Soong grade 2, four as Soong grade 1 and none as grade 0. The difference between the Soong groups was statistically significant ( p = 0.006). Flexor tenosynovitis was present in eight patients (7%) and more likely in patients with a higher Soong grade ( p = 0.026). We conclude that higher Soong grades are associated with significantly more flexor tendon complications. Therefore, elective removal of the palmar plate after union of the fracture should be considered in patients with Soong grades 1 and 2. Level of evidence: IV

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

“…Previous research has confirmed that higher Soong grades are associated with significantly more flexor tendon complications. 9 , 12 , 28 , 31 Our results further confirmed that both the Soong grade and the quantitative measurements of PCLD and PVRD can help surgeons identify patients at risk for tendon rupture. Patients with Soong grade 2 plates have an increased risk of rupture, as do patients with distal plates that extend within 3.0 mm of the volar rim (PVRD of <3.0 mm) or >2.0 mm volar to the critical line (PCLD of >2.0 mm).…”

“…9 , 10 The flexor pollicis longus (FPL) is the most frequently ruptured tendon, followed by the index flexor digitorum profundus. 11 , 12 Symptoms and signs of FPL attrition or rupture include pain and a rubbing sensation with movement, sometimes preceded by volar radial-sided wrist pain, volar wrist swelling, a popping or clicking sensation, and even an inability to flex the interphalangeal joint of the affected phalanx. 13–16 In view of the above problems, we should strive to identify the risk factors for tendon attrition or rupture and to intervene accordingly.…”

Effect of age on the outcome of reconstruction for flexor tendon rupture following distal radial fracture

“…Effect of age on the outcome of reconstruction for flexor tendon rupture following distal radial fracture Dear Editor, Surgical treatments for flexor tendon ruptures include tendon transfer, tendon grafting and primary repair. However, there is no consensus regarding the optimal procedure to manage these injuries following anterior locking plate fixation (Casaletto et al, 2009;Gören et al, 2020) or non-operative management (Komura et al, 2019) for distal radial fractures. The outcomes of reconstructive surgery remain uncertain because of the limited number of reported cases.…”

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

“…17 Other studies report similar results in that most ruptures or tenosynovitis occurred in patients with Soong grade 2 plate placement. 6,[18][19][20] In patients with Soong grade 1, a higher risk for tendon rupture has been reported if the plate protrudes the critical line by more than 2 mm and if the distance from the plate to the volar rim is less than 3 mm. 18 Some theorize that the distal positioning of the plate leads to increased contact pressure on the tendon, especially during extension of the wrist.…”