Incidence of Flexor Pollicis Longus Complications Following Volar Locking Plate Fixation of Distal Radius Fractures

Abstract

Background: Distal radius fractures are among the most common orthopedic injuries presenting to emergency departments. The complications of distal radius open reduction and internal fixation (ORIF) range from paresthesia to tendon ruptures. The Soong grading system was designed to evaluate volar plate position to predict postoperative flexor pollicis longus (FPL) ruptures. This study evaluates post-distal radius volar fixation FPL ruptures and other postoperative complication rates relative to Soong grade, surgical training, and plate design. Methods: A retrospective chart review was conducted to assess recorded complications after distal radius ORIF. Soong grade was determined on postoperative radiographs. Other demographic features, along with the surgeon fellowship training and plate design, were noted. Analysis was performed via t test, χ2 test, rank sum test, and Fisher exact test. Results: A total of 522 patients met inclusion criteria. Flexor tenosynovitis was the most commonly recorded complication (21% of total complications). No FPL ruptures were recorded. Soong grades between patients with and without complications were not significantly different. Soong grades between patients with flexor tenosynovitis and other complications were not significantly different. Flexor tenosynovitis had higher odds of occurring compared with other complications when the surgeon was hand-trained or when the plate type was designed by Acumed. These higher odds were not maintained under multivariate regression analysis. Conclusion: Lack of FPL ruptures in this large series may reflect improved plate technology and increased awareness. The association between flexor tenosynovitis and hand fellowship–trained surgeons may be associated with more complex cases being referred to specialists.

Analysis of Postoperative Complications and Related Factors Affecting Prognosis in 50 Patients with Distal Radius Fractures

“…e reason is that bleeding after a fracture and local injection of anesthetic drugs will cause the pressure in the carpal tunnel to increase and oppress the median nerve, leading to carpal tunnel syndrome. e bone mass and quality of the distal radius are low, so the fracture degree of fracture is relatively large, and the bone blood supply and repair ability are also poor, resulting in difficulty in reduction and traumatic arthritis [19][20][21].…”

Functional Outcomes Following Fixation of an Ultra-distal Radius Fracture with Two Commonly used Volar Locking Plates: A Retrospective Cohort Study

“…In spite of these disparate de nitions, the watershed line has been widely used as a distal reference point for distal radius volar plating positioning to avoid exor tendon irritation, tenosynovitis and rupture (1,7,9). Soong et al de ned the watershed line as" the most prominent part of the volar surface of the distal part of the radius, where the exor tendon lies closest to the plate and bone" [6].…”

“…In previous studies, the incidence of FPL iatrogenic injury after Acumed Acu-Loc VLP use has been widely reported (4,6,7,9). A common concern is the ange design of the plate extended toward the radial styloid; even when shaved to a thinned edge, the design is believed to be related to exor pollicis longus tendon complications (6).…”

“…However, distal radius VLP also predisposes the patient to several speci c complications. Upon distal radius VLP xation, overall complications range between 5-27%, and include; carpal tunnel syndrome, malunion, intra-articular screw trajectory, mal-positioning of the plate, prominent hardware, possible exor or extensor tendon irritation, and potential rupture (1,(6)(7)(8). Numerous studies have demonstrated a relationship between exor tendon irritation (i.e.…”

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

“…Volar plate fixation has become the mainstay of surgical treatment for distal radius fractures. 1,2 The incidence of flexor tendon ruptures following volar plate fixation ranges from 0.5 to 2%, [3][4][5][6][7][8][9][10][11][12] whereas this was as high as 12% in earlier reports. 13 Flexor pollicis longus (FPL) tendon ruptures are the most common, seen in more than half of the tendon ruptures, generally occurring within 1 to 2 years after plate fixation.…”