Complications following palmar plate fixation of distal radius fractures: a review of 665 cases

Abstract

Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.

The effects of the Frag-Loc® compression screw on distal radius fracture with a displaced dorsoulnar fragment

“…Although palmar locking plate fixation is a good treatment option for most distal radius fractures, the palmar locking plate has some complications and limitations. The overall complication rate ranges from 8 to 39 % and can include complex regional pain syndrome type I and damage to both the flexor and extensor tendons [12][13][14]. The palmar locking plate has limitations when used to treat several clinical conditions including AO/OTA C3 type fracture and small volar rim fracture with comminution.…”

“…Use of the palmar locking plate after open reduction is the most common surgical treatment for unstable distal radius fracture [1,12,13]. Although palmar locking plate fixation is a good treatment option for most distal radius fractures, the palmar locking plate has some complications and limitations.…”

“…The proper depth for insertion of the distal locking screws into the dorsoulnar fragment is important to achieve sufficient fixation power and interfragmentary compression. Nevertheless, most surgeons hesitate to apply the screws to the proper depth because of concern that it could lead to secondary problems with the extensor tendon problems if it should be penetrated by the screw tips [12]. Dorsal plate fixation using the dorsal approach provides the surgeon with the advantages of direct visualization and reduced dorsoulnar fragment.…”

The operative treatment of fractures of the distal radius is increasing

“…6 The angle-stable screws gave more secure fixation, even in severely osteoporotic bone, 7,8 and the volar position of the plate proved to give rise to fewer complications from impingement by tendons. 5,9 The risk of complications after volar plating in terms of tendon rupture, hardware problems and nerve compression is reported to be approximately 10%, 10 and between 15% and 34% of patients have their hardware removed within a year. [11][12] Published studies that compare the clinical outcomes of volar plating and external fixation have shown that those treated with a volar plate return to normal function more quickly but the long-term outcome is equal after both treatments.…”

No Difference in Adverse Events Between Surgically Treated Reduced and Unreduced Distal Radius Fractures

“…5 Assuming a relevant difference of 20% in adverse events between reduced and unreduced fractures (ie, a rate of 31.3% in our unreduced patients), an a priori sample size calculation indicated that a sample size of 150 with an allocation ratio of 0.5 (reduced n = 100, unreduced n = 50) would provide 80% power to show a difference in adverse event rates with alpha set at 0.05 (Z-test, 2 independent proportions, G*Power 3.1).…”