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. 2024;12(12):835-839.
doi: 10.22038/ABJS.2024.77674.3587.

Risk for Flexor Pollicis Longus Rupture after Volar Lock Plating for Distal Radius Fracture Lasts Over a Decade

Panu H Nordback  1   2 , Ellen Y Lee  1 , Jin Xi Lim  1 , Aymeric Yt Lim  1 , Soumen Das De  1
Affiliations

Risk for Flexor Pollicis Longus Rupture after Volar Lock Plating for Distal Radius Fracture Lasts Over a Decade

Panu H Nordback et al. Arch Bone Jt Surg. 2024.

Abstract

Objectives: Volar locking plate (VLP) fixation is a very common procedure due to the high incidence of distal radius fractures (DRFs). Attritional flexor tendon rupture is a rare, but recognized complication after VLP fixation. There is no current consensus to prevent the condition. Our objective was to highlight the long-term risk for flexor tendon rupture after VLP fixation.

Methods: We conducted a retrospective single-center review of patients with attritional flexor tendon rupture after VLP fixation for DRFs between 2016 and 2021. Patient demographics, DRF details including AO fracture classification, Soong grading and tendon reconstruction were collected. Thumb interphalangeal joint (IPJ) motion and Kapandji score were used as outcome measures for the tendon reconstruction.

Results: We identified five patients with attritional flexor pollicis longus (FPL) ruptures. The median age of the patients at the time of DRF was 48 (34-56) years. All VLP fixations were Soong grade 2. Median time from VLP fixation to tendon rupture was 7 (3-14) years. Longest surgery-to-rupture interval was 14 years. One rupture was treated conservatively. Four were reconstructed using palmaris longus (PL) tendon graft. Thumb IPJ active range of motion median was 48 (20-55) degrees and Kapandji score 9/10 (7-9/10).

Conclusion: Older generation VLP fixations with Soong grade 2 pose a long-term risk for attritional FPL rupture, which can be reconstructed with PL tendon graft with fair to good outcomes.

Keywords: Distal radius fracture; Flexor pollicis longus; Flexor tendon rupture; Tendon reconstruction; Volar locking plate fixation.

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Conflict of interest statement

The authors do NOT have any potential conflicts of interest with respect to this manuscript.

Figures

Figure 1
Figure 1
All plate positions were categorized as Soong grade 2 as shown
Figure 2
Figure 2
Case with 14-year interval from VLP fixation to FPL rupture. The fixed-angle volar locking plate was prominent (Soong 2). Attritional rupture of the FPL tendon was noted, with an approximately 5-centimetre gap between the retracted tendon ends (white asterisk). The FPL rupture was repaired within three months using an ipsilateral interpositional palmaris longus autograft. The patient also underwent removal of implants, flexor tenolysis, scar revision, and a carpal tunnel release. The final result was 45 degree of active motion at the thumb IPJ and the patient was satisfied
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