Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates

Abstract

Objective: Anatomic volar rim locking plates are designed with the aim of treating intraarticular distal radius fractures. When used to treat comminuted distal radius fractures, these plates can damage the flexor tendons. In this study, we sought to determine the radiological and functional results and rate of complications of these plates.

Methods: We retrospectively reviewed the records of 36 patients (28 males, 8 females; mean age: 46.4 years) with AO/OTA Type C2-C3 distal radius fractures treated with anatomic volar rim distal radius plates between January 2011 and December 2014. Radial length, radial inclination and palmar tilt were compared with the intact wrist. Results were evaluated with the Mayo wrist and Lidstrom scores. Complications were documented throughout the follow-up period of 23.8 (range: 12 to 48) months.

Results: Postoperative measurements of the radial length, inclination and palmar tilt did not differ significantly. Mayo wrist and Lidstrom scores were good and excellent in 27 and 32 patients, respectively. Flexor tenosynovitis was symptomatic in 15 patients and asymptomatic (localized swelling only) in 21. Plates were removed from 15 patients due to symptomatic tenosynovitis and from six patients due to partial rupture of the flexor pollicis longus tendon. The flexor digitorum profundus tendon of the second finger was also partially ruptured in three patients.

Conclusion: Anatomic volar rim locking plates provide satisfying radiological and functional results in treating AO/OTA Type C2-C3 comminuted distal radius fractures. However, if these plates interfere with the union of the fracture, they should be removed to avoid potential tendon problems caused by their placement in the rim region.

Level of evidence: Level IV, Therapeutic study.

Keywords: Distal radius fracture; Flexor tendon complications; Intraarticular fracture; Volar plating.

Fig. 1

(a, b) Preoperative and (c, d) 14-month postoperative anteroposterior and lateral views of the left wrist of a 39-year-old man treated with a volar locking rim plate.

Fig. 2

Images of a 36-year-old man with AO/OTA Type C3 distal radius fracture. (a) Peroperative view of the volar rim and (b) position of the plate. (c) A 15-degree Kirschner wire was used as reference for screw angulation by using fluoroscopy.

Fig. 3

Fourteen months after surgery, swelling on the wrist of the patient from Fig. 1 can be seen as he makes a fist.

Fig. 4

Removal of the volar plate from the patient in Fig. 1, 18 months after placement, to reduce symptomatic tenosynovitis. (a) Synovitis around the plate. (b) Synovitis on the flexor pollicis longus (FPL) tendon. (c) Partial rupture on the FPL tendon. (d) Contact of the FPL tendon with the volar plate.

Fig. 5

(a) Loss of flexion in the second finger caused by plate-induced tendon damage. (b) Extensive synovitis around the median neuron and flexor tendons. (c) Synovitis around the deep flexor tendons. (d) Partial tendon damage (>60%) in the second finger flexor.