An Analysis of Tendon Injuries Accompanying Distal Radius Fractures Using Volar Locking Plates

Abstract

We examined 6 cases of tendon injuries that accompanied distal radius fractures using volar locking plate between April 2006 and March 2012. Male: one case, female: five cases, average age 57.0 (33~70) years old. The fracture type was A2 in one case, A3 in four cases, and C2 in one case by AO classification. The average period for operation waiting was 2.7 days. We analyzed the time of occurrence of tendon rupture (extensor pollicis longus (EPL)･flexor pollicis longus (FPL)), the existence or not of screw prominence and dorsal roof fragment, and the positioning of the plate setting. The tendon ruptures were EPL in four cases, and FPL in two cases. The average period of rupture occurrence was 86.8 (1~182) days. In four EPL tendon ruptures we recognized one marked screw prominence (16.7%), and two dorsal roof fragments (50%), both showing widespread displacement. Moreover, we recognized the malposition of the plate setting in the two cases of FPL tendon rupture (100%). The incidence of tendon ruptures accompanying distal radius fractures using volar locking plates was not low at all, therefore we should more pay attention to the prevention of this occurrence.

Extensor Tendon Injury After Volar Locking Plating for Distal Radius Fractures: A Systematic Review

“…The average time to rupture after VLP fixation is around 3 months. 10 After this time, extensor tendon injury as a complication of VLPs is less likely but can still be considered, as 1 case study found delayed rupture of the extensor digitorum communis linked to dorsal screw prominence 7 years after initial fixation. 8 Multiple extensor tendons may rupture, potentially presenting at different times postoperatively.…”

“…13 In individual studies, the reported risk of extensor tendon rupture ranges from 0% to 12.5% (Table 1). [2][3][4]10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The reported risk of extensor tendon irritation or tenosynovitis ranges from 1.1% to 23.9%.…”

“…19 One case series found that dorsal roof fragments could be identified on half of patients with EPL rupture following volar plating. 10 Fracture type and healing patterns also influence the likelihood of extensor tendon irritation; in particular, "island-shaped" fractures of Lister's tubercle are associated with narrowing of the EPL groove via callus formation and thus increased risk of EPL rupture after volar plating. 30 Therefore, when considering the risk of extensor tendon injury in the treatment of DRFs, it is important to remember the many risk factors before surgical management begins.…”

Incidence of Flexor Pollicis Longus Complications Following Volar Locking Plate Fixation of Distal Radius Fractures

“…Extensor tendon rupture has primarily been attributed to screw prominence. 9 The flexor pollicis longus (FPL) is the most common flexor tendon to rupture in association with VLP fixation as it courses directly over the rim of the distal radius. 10,11 The exact cause of FPL tendon ruptures remains unknown; however, reports suggest that prominence of the volar plate over the volar rim of the distal radius may contribute to higher rupture rates.…”