Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events.

Abstract

OBJECTIVES:

Determining the rate of specific adverse events after volar plating performed for distal radius fractures.

DESIGN:

Retrospective.

SETTING:

University level I trauma center.

PATIENTS:

We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up.

INTERVENTION:

Volar plate fixation for the treatment of distal radius fractures.

MAIN OUTCOME MEASUREMENTS:

At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation.

RESULTS:

Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues.

CONCLUSIONS:

The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement.

LEVEL OF EVIDENCE:

Therapeutic level IV.

• Authors: Luigi Tarallo, Raffaele Mugnai, Francesco Zambianchi, Roberto Adani, Fabio Catani
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 27 Issue 12 Pg. 740-5 (Dec 2013) ISSN: 1531-2291 [Electronic] United States
• PMID: 23515129 (Publication Type: Journal Article)

Topics

• Adolescent
• Aged
• Aged, 80 and over
• Bone Plates (adverse effects, statistics & numerical data)
• Female
• Fracture Fixation, Internal (instrumentation, statistics & numerical data)
• Hand (surgery)
• Humans
• Italy (epidemiology)
• Male
• Middle Aged
• Postoperative Complications (diagnosis, epidemiology, etiology)
• Prosthesis-Related Infections (diagnosis, epidemiology, etiology)
• Radius Fractures (epidemiology, surgery)
• Retrospective Studies
• Treatment Outcome
• Wounds, Penetrating (diagnosis, epidemiology, etiology)
• Wrist Injuries (epidemiology, surgery)
• Young Adult