Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

Abstract

Background: Volar locking plates provide significant structural stability to the distal radius. Failure of a volar locked plating is a rarely reported complication in the literature.

Case presentation: A 40 year-old, obese female patient who presented with a displaced extraarticular distal radius fracture, underwent open reduction and internal fixation of the fracture using a volar locking plate. Radiographs taken at 10 weeks postoperatively showed failure of fixation with breakage of the four distal locking screws. A hardware removal was performed at 6 months, and the patient was then lost to follow-up. She presented again at 18 months after the first surgery, with significant pain, and radiographic signs of a radial collapse and a fracture-nonunion. A total wrist fusion was performed as the method of choice at that point in time.

Conclusion: Volar locked plating represents the new "gold standard" of distal radius fracture fixation. However, despite the stability provided by locking plates, hardware failure may occur and lead to a cascade of complications which will ultimately require a wrist fusion, as outlined in this case report. Additional structural support by bone grafting may be needed in selected cases of volar locked plating, particularly in patients with a high risk of developing a fracture-nonunion.

Figure 1

Initial radiographic view of the right wrist following failure of reduction in 1 week.

Figure 2

Radiographs show collapse of the fracture following failure of screws. Despite the collapse, the lateral radiograph showed neutral alignment of the distal radius articular surface with minimal shortening on the posteroanterior (PA) plane.

Figure 3

Twelve months after the removal of the plate, patient continued to have symptoms. Patient refused to have CT scan of her wrist as she had severe claustrophobia. Radiographic view obtained at the time showing bridging callus (arrows), however the diagnosis of nonunion was still not excluded before the surgery.

Figure 4

Twelve months after the last surgery, radiographs show consolidation at the nonunion site. Patient at this point is pain-free and has full forearm rotation.