Mechanical Failure of the Distal Radius Volar Locking Plate

Abstract

Purpose. To review 9 cases of mechanical failure of the volar locking plate for distal radial fractures. Methods. Records of 374 consecutive patients who underwent volar locking plating for distal radial fractures were reviewed. Mechanical failures of the volar locking plate were defined as plate breakage or bending, screw breakage or loosening, or collapse of articular fragments resulting in intra-articular screw extrusion. Results. Nine mechanical failures occurred between 2 weeks and 3 months in 8 (2.4%) of the patients aged 25 to 82 (median, 74) years with AO fracture types of A3 (n=4), C1 (n=1), C2 (n=1), and C3 (n=3). Mechanical failures included screw pullout (n=5), locking plate bending (n=2), locking screws breakage (n=1), and loosening of locked variable angle screws (n=1). One patient underwent revision of fixation and 2 underwent implant removal. The remainder were treated conservatively. All patients were followed up for a minimum of 12 months; their mean flexion arc was 87° (standard deviation [SD], 17°) and the mean rotation arc was 136° (SD, 29°). According to the Green and O'Brien score, their outcomes were good (n=1), fair (n=4), and poor (n=3). Conclusion. Although mechanical failure of volar locking plate is uncommon, some are potentially preventable.

Distal radius re-fracture with bending of implant and neurovascular compromise

“…1 Volar locking plates have gained popularity because of their wider availability and reliability of the locking technology adapted to the wrist. 2 Although there are no studies yet to demonstrate that these plating techniques are associated with better outcomes compared to sufficiently reduced nonsurgical management strategies, it does serve a purpose in specific patient populations. 1 However, it must be recognized that this surgical technique can be associated with complications and failures that are widely reported in the medical literature.…”

“…1 However, it must be recognized that this surgical technique can be associated with complications and failures that are widely reported in the medical literature. 2 Mechanical failure of the volar locking plate devices are considered to be rare complications with failure being defined as plate breakage/ bending, screw breakage/loosening, or collapse of articular fragments resulting in intra-articular screw extrusion. 2 This particular case illustrates an exceedingly rare example of a peri-implant re-fracture due to trauma, resulting in bending of the implant and a fracture of the bone beneath the plate.…”

Volar Locking Plate Breakage after Nonunion of a Distal Radius Osteotomy

“…Breakage of VLP is an uncommonly reported complication [1–7]. A review of over 350 patients with volar locking plate described 9 mechanical failures, including screw failure (7) and plate bending (2), but none with plate breakage [8]. …”

Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

“…Indeed, distal volar locking plates (DVLP) are frequently used because of the small size of VLFF [6,7]. However, many complications of DVLP, such as flexor tendon injury and crushing of VLFF, have been reported, demonstrating them to be an implant with a high risk for postoperative complications [8][9][10][11]. Therefore, reconsideration of their indications may be necessary.…”