Incidence of tendon ruptures after locking plate fixation of distal radial fractures: are the cited rates still accurate?

Abstract

With the introduction of the anterior locking plate in the early part of this century, there was a large change in how distal radial fractures were treated. Early articles about the techniques reported tendon ruptures occurring in as many as 10%, although studies from our unit reported rates closer to 2%. Subsequent refinements in surgical technique and improvements in plate design have been made with the aim of reducing the number of ruptures. Despite this, the original articles and their rates continue to be quoted. In this retrospective study of 798 cases treated with anterior locking plates, tendon ruptures have been significantly reduced and are now as low as 0.5%. Contributing factors leading to this improvement are identified and discussed. Level of evidence: III

Low Rates of Hardware Removal and Tendon Rupture for the Acu-Loc 2 Volar Distal Radius Plate: A Minimum One-Year Follow-Up Study

“…Brown et al conducted a retrospective study involving 798 patients who underwent fixation with either the Acu-Loc 2 VDR plate, the Acu-Loc 2 proximal VDR plate, or the DVR plate for their distal radius fractures [ 23 ]. The study aimed to assess the rate of tendon rupture using the same methodology as the original articles which quote high tendon rupture rates after use of a VLP.…”

Modes of failure following locking plate fixation of the distal radius: a thematic analysis of 517 fractures

“…If inadequate stability is achieved with volar plating of comminuted fractures, then supplementary dorsal plating can be utilized. The anatomic anterior plate can act as a template, then the dorsal supplementary plate buttresses the fragments against it (Brown, 2020).…”

“…The success of anterior locking plate fixation is generally good, with positive patient-reported outcomes for treating intra-articular fractures (Anakwe et al., 2010). The reported surgical complication rate is generally low, the most common of which is tendon irritation or rupture historically cited as in the range of 2%–10%, but some have reported rates as low as 0.5% (Brown et al., 2021). There are some reported instances of mechanical failure after anterior locking plate fixation; however, these are likely to be under-represented in the literature.…”