Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

Abstract

Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

Complications after operatively treated distal radius fractures

“…An additional irritation or rupture of the flexor tendons, especially the FPL tendon, can occur due to screw loosening or a palmar protruding plate [93,94]. Precise positioning of the plate not too far ulnarly is imperative, as this can block the distal radioulnar joint [49].…”

Minimally Invasive Pronator Quadratus Sparing Approach versus Extended Flexor Carpi Radialis Approach with Pronator Quadratus Repair for Volar Plating in Distal Radial Fractures

“…[2][3][4][5]11 Proponents of PQ repair advocate that the PQ acts as a protective sleeve for the flexor tendons, although all agree plate positioning in reference to the volar rim is the main determinant to prevent flexor tendon friction and tendinosis. [8][9][10][11][12][13] Previous authors noted that PQ repair is generally durable, but surgeons may experience difficulties to achieve a successful plate-covering PQ repair in the presence of an atrophic PQ in elderly patients or a damaged PQ due to fracture displacement. 12,14 This problem is bypassed in a pronator sparing approach.…”

“…8,9 In case of a marginal fracture distal to the watershed line, an FPL-adapted plate (Medartis, Basel, Switzerland) was used. 10 The plate was secured temporarily to the epiphyseal part of the radius using a 25 mm long and 1.6 mm diameter threated compression Kirshner wire (K-wire) (DePuy Synthes, Oberdorf, Switzerland) in preference to the second radial hole of the distal row, parallel to the articular surface (►Figs. [3][4].…”

A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating

“…Fragment-specific plates may also reduce plate-tendon conflict. 27 T ¼ TFCC Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating Goorens et al…”