Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures

Abstract

BackgroundThe aim of this study was to evaluate the complication rates of volar versus dorsal locking plates and postoperative reduction potential after distal radius fractures.Materials and methodsFor this study 285 distal radius fractures (280 patients/59.4 % female) treated with locked plating were retrospectively evaluated. The mean age of the patients was 54.6 years (SD 17.4) and the mean follow-up was 33.2 months (SD 17.2). The palmar approach was used in 225 cases and the dorsal approach in 60 cases (95 % type C fractures).ResultsAdequate reduction was achieved with both approaches, regardless of fracture severity. In the dorsal group, the complications and implant removal rates were significantly higher and the operative time was also longer.ConclusionsBased on these facts, we advocate the palmar locking plate for the vast majority of fractures. In cases of complex multifragmentary articular fractures where no compromise in reduction is acceptable, and with the biomechanical equality of palmar and dorsal plating remaining unproven, dorsal plating may still be considered.Level of evidenceTherapeutic level IV.

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures

“…Of these, infection appears to be the most common, affecting between 0-2.6% of patients. (35,48,51,83,99) There exist also complications specific to any plating, that are not specific to the plate type, such as re-fracture or peri-prosthetic fracture secondary to new trauma.…”

“…While some plates are removed as a result of other complications such as tendon rupture, infection, or malunion, many patients request to have their plates removed for discomfort associated with the retained plate, decreased range of motion, pain, or anxiety related to the plate. It appears as though the all-cause incidence of hardware removal lies between 0-26%, (35,48,49,51,100) with significant variation depending on clinician preference.…”

“…Currently, a number of volar plate options exist, including fixed-angle and variable-angle locking plates, with their own potential complication profiles: Rates of nerve complications range from 0.4-14%, with CTS being the most commonly reported type. (38,48,51,74,94,99,102,103) One large multi-institutional retrospective study by Satake et al identified 694 patients treated by volar locking plate, of which only 4 cases of tendon rupture (0.6%) were reported, while 18 cases of CTS (2.6%) and 3 cases of CRPS (0.4%) were reported, indicating a greater incidence of nerve complications than tendon complications. (93) Reported rates of hardware-related complications range from 0-7%, with malunion being the most frequent.…”

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon’s perspective

“…Both permit sufficient reduction and provide good functional results [2], [3]. Approach-related complication rates, such as tendon ruptures or complex regional pain syndrome seemed to be similar for both approaches in recent studies [4], [5]. …”

Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating

“…19,25 Proponents of this method cite biomechanical benefits, procedural advantages, and potentially lower complication rates compared with dorsal plating options. 34 Despite the benefits offered with volar plating, a seemingly rare consequence of using this technique is irritation and subsequent rupture of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendon to the index finger. Depending on plate position and screw length, other tendons may be at risk as well.…”