Early Complications of Volar Plating of Distal Radius Fractures and Their Relationship to Surgeon Experience

Abstract

Background Fractures of the distal radius are among the most common fractures in adults. Recently, there has been a trend towards open reduction and internal fixation of these fractures through a volar approach. The purpose of this study was to assess the early complications of volar locking plate fixation of distal radius fractures with an emphasis on defining the relationship between surgeon experience and incidence of complications. Materials and Methods Following IRB approval, we conducted a retrospective chart review of the initial 96 distal radius fractures (92 patients) treated by open reduction and internal fixation of distal radius fracture using a volar locked plate. Our outcome measurements were incidence of postoperative complications and radiographic loss of reduction. Results Twenty-two complications occurred in 21 patients. Of these, five complications (5%) required surgical treatment or hospitalization. Seventeen complications (18%) required no surgical intervention or hospitalization. Transient nerve dysfunction was the most common complication, accounting for 12 of 22 complications. The first 30 patients experienced significantly more complications than those treated later in the series (p=0.03). There was a trend towards increased incidence of complications in cases where more than 10 days elapsed between injury and surgery or where supplementary Kirschner wire fixation was used. There was no correlation between patient age, sex, severity of fracture, or presence of ulnar styloid fracture and the development of complications or loss of reduction. Discussion The incidence of complications decreased significantly with increased surgeon experience, suggesting that many of these early complications are avoidable.

Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures

“…However, improving the surgical technique and reducing the surgical waiting time could effectively avoid some early complications such as nerve dysfunction, infection, etc. (Ward et al, 2011). Other complications such as postoperative continuous wrist pains, tendon injuries, tenosynovitis, etc.…”

Distal radius fractures in the athlete

“…There is an increased risk of median nerve dysfunction after volar approaches to the distal radius with reported incidence from 0 to 10.2% [39][40][41][42][43][44]. However, most of these symptoms are mild and self-limited resolving in the first few months after surgery.…”

“…Rates of postoperative flexor tendon rupture are reported from 0 to 1.8% [20,39,[41][42][43][44]. This risk can be reduced by ensuring the entirety of the plate remains proximal to the transverse ridge at the distal aspect of the radius, keeping the distal plate tightly applied to the bone, and restoring the volar tilt of the radius [20,45,46].…”

“…Although this can occur following nonoperatively treated fractures, prominent screws placed from volar plates have been implicated in postoperative ruptures. Extensor tendon ruptures complicate up to 6.5% of distal radius fractures treated with a volar locking plate [39,[41][42][43][44].…”

Wrist malpractice claims in Northern Norway 2005–2014. Lessons to be learned

“…To minimise complications and malpractice on a system level, health care administrators may run campaigns to improve staff’s attention during treatment, for example the “safe surgery campaign” [9,10]. Another and maybe more important measure is the effort to reduce the number of complications by improving surgeons’ expertise or skills [11] or by giving better training and supervision [12]. Pappas et al [12] recommended that hand surgeons should stay updated within their field of surgery, know their department’s quality of care figures and be aware of the present national and international guidelines.…”