Union of an intra-articular distal radius fracture after successive failures of three locking plates: a case report

Abstract

We report a case of a 30-year old male, who presented with a right distal radius intra-articular fracture complicated by compartment syndrome. He was treated with fasciotomies and fracture fixation with a 3.5 mm LCP (Synthes(™)), followed 7 days later by skin graft. Repeat radiographs 8 weeks later showed a break across the plate at the level of an unfilled screw hole over the fracture. He underwent exchange plating with a 2.4 mm LCP Distal Radius Plate (Synthes(™)). This revision was complicated by an infected wound dehiscence 2 weeks later requiring multiple procedures. Radiographs at 20 weeks showed broken distal screws. A second revision was performed. At 12 months, the fracture had healed clinically and radiologically, but the three distal screws had broken. We discuss the multifactorial failures of the these three attempts at osteosynthesis, and which factors helped achieve osseous union. We also discuss the literature on volar locking plate breakage and conclude with the recommendations to avoid this rare complication.

Fig. 1

Radiographs after injury, showing the distal radius fracture

Fig. 2

Radiographs at 6 weeks after the index procedure. Broken plate

Fig. 3

Radiographs at 20 weeks after the first revision procedure

Fig. 4

Radiographs at 26 weeks after the first revision procedure. Broken screws

Fig. 5

Radiographs at 6 weeks after the second revision procedure (with bone graft)

Fig. 6

Clinical examination at 6 weeks after the second revision

Fig. 7

Radiographs at 1 year after second revision

Fig. 8

Suggested causes for sequential failures of the three plates