Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature

Abstract

Background: Flexor tendon rupture is a rare but major complication associated with volar plate fixation of distal radius fractures.

Materials and methods: We performed a systematic review to evaluate the demographics, clinical profile, treatment and outcome of flexor tendon rupture following volar plate fixation of distal radius fracture. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases for systematic reviews and conference proceedings were performed. Studies were included if they reported flexor tendon rupture (partial or complete) as a complication of distal radius fracture plating (all levels of evidence).

Result: Our search yielded 21 studies. There were 12 case reports and 9 clinical studies. A total of 47 cases were reported. There were 11 males and 23 females (n = 16 studies). The mean age was 61 years old (range 30-85). The median interval between the surgery and flexor tendon rupture was 9 months (interquartile range, 6-26 months). Twenty-nine plates were locking and 15 were nonlocking (n = 20 studies). FPL was the most commonly ruptured tendon (n = 27 cases, 57 %), with FDP to index finger being the second most common (n = 7 cases, 15 %). Palmaris longus tendon graft and primary end-to-end repair were the most common surgical methods used in cases of FPL tendon rupture.

Conclusion: Flexor tendon rupture is a recognised complication of volar plating of distal radius fracture. Positioning of the plate proximal to the "watershed" line and early removal of the plate in cases with plate prominence or warning symptoms can reduce the risk of this complication.

Fig. 1

Bar chart demonstrating the age distribution of the patients with flexor tendon rupture following volar plate fixation of distal radius fracture

Fig. 2

Box plot of the interval between the surgery and flexor tendon rupture

Fig. 3

Seventy-five-year-old male with FPL and FDP to index finger ruptures following volar plating of distal radius fracture

Fig. 4

Lateral X-ray showing a slightly prominent distal edge of the plate

Fig. 5

MRI showing FPL rupture (white arrow) and close proximity of the flexor tendon to the volar plate (MRI performed before FDP to index finger rupture)

Fig. 6

Intraoperative picture showing the frayed ends of the ruptured FDP and FPL

Fig. 7

Functional outcome at the 14-month follow-up

Fig. 8

Schematic presentation of the watershed line and flexor tendon impingement over a prominent distal plate edge. PQ pronator quadratus, FT flexor tendon