Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review

Azzi, Alain J.; Aldekhayel, Salah; Boehm, Kaitlin S.; Zadeh, Teanoosh

doi:10.1097/prs.0000000000003076

Cited by 58 publications

(33 citation statements)

References 73 publications

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“…In a systematic review of tendon complications following open reduction and internal fixation of distal radius fractures, Azzi et al similarly found a low incidence of tendon complications following volar plating. 69 Their systematic review reported a 7.5 versus 4.5% tenosynovitis and 1.7 versus 1.4% tendon rupture rate following dorsal plating and volar locked plating, respectively.…”

Section: Discussionmentioning

confidence: 98%

Complications of Volar Plating of Distal Radius Fractures: A Systematic Review

et al. 2018

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Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear. Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF. Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up. Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%). Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.

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Section: Discussionmentioning

confidence: 98%

Complications of Volar Plating of Distal Radius Fractures: A Systematic Review

et al. 2018

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“…Beyond the distress of both surgeon and patient, this attention is also justified from a cost standpoint. Distal radius hardware removal for plate prominence and tendon rupture cost the health care system over $15.2 million annually, 10,[21][22][23] and this surgical expense is dwarfed by the cost of time of work, extra clinic visits, therapy, prescription drug, and caretaker costs, which easily double or even triple this number. 2 This expense is an additional motivating force toward design innovation, which has succeeded in bringing a plethora of new plates to market.…”

Section: Discussionmentioning

confidence: 99%

“…6 Flexor tendon rupture is the most well described late complication, with rates reported between 0.8 to 12%, [7][8][9] and a recent meta-analysis finding the incidence to be 1.5%. 10 The two most common flexor tendons affected are the flexor pollicis longus (FPL) and the index flexor digitorum profundus (FDP), which are associated with 57 to 75 and 15% of cases, respectively. 11,12 A well-recognized factor leading to tendon irritation is plate placement in relation to the most distal volar ridge of the radial metaphysis, known as the watershed line.…”

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confidence: 99%

Impact of Design on Force between Flexor Tendons and Distal Radius Volar Plates

et al. 2019

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Background Flexor tendon injury is a rare but serious complication of distal radius volar plating. Purpose This study aims to determine whether the design of distal radius volar plates impacts the amount of force exerted on the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons when the plates are placed proximal and distal to the watershed line. Methods Three commercially available plates were applied to 10 fresh, matched-pair upper extremity specimens. Cyclical loading was applied to the tendons, and the force generated between tendon and plate was measured. Linear mixed effect models were used to evaluate differences in maximum and mean forces by plate position, plate design, and the interaction between position and design. Results Forces on the tendons differed significantly by position but not plate design. For the FPL tendon, the average maximum force with a plate in Soong's grade 2 was 4.50 (95% confidence interval [CI]: 2.8–7.3) times higher than when the plate was in a Soong's grade 0 placement, and 4.63 (95% CI: 2.82–7.61) times higher for the FDP tendon. While not statistically significant, lower observed force values with thinner plates when plates were placed distal to the watershed line suggest that that plate thickness could also be a critical plate characteristic for distally placed plates. Conclusion Despite differences in plate design, the main determinant of plate prominence and therefore flexor tendon injury potential is placement in relation to the watershed line. Clinical Relevance This study may help to guide surgeon implant selection and volar plate design.

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“…Auch einliegendes Osteosynthesematerial, wie z. B. bei palmar versorgter distaler Radiusfraktur, kann durch mechanische Irritation der darüber liegenden Beugesehnen zu einer gedeckten Verletzung führen [1,4]. [22].…”

Section: Verletzungsursachenunclassified