Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study

Yamazaki, Hiroshi; Uchiyama, Shigeharu; Komatsu, Masatoshi; Hashimoto, Shun; Kato, Hiroyuki

doi:10.1016/j.jhsa.2015.03.023

Cited by 17 publications

(4 citation statements)

References 32 publications

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“…However, repaired PQ is not always suitable for covering the edge of the plate because the coverage depends on the plate location, plate shape, and quality of remaining PQ. 15 Further investigation is necessary to determine the validity of PQ repair after VLP fixation.…”

Section: Discussionmentioning

confidence: 99%

Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases

Sato

Murakami

Mimata

et al. 2018

Journal of Orthopaedics

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This study assessed the comprehensive incidence of tendon rupture following volar locking plate (VLP) surgery for a large number of patients with distal radius fractures (DRFs) at multiple facilities in one prefecture, Japan. During the 4-year period, 2787 patients with DRFs underwent fixation using VLP. The overall incidence rates of rupture of the FPL, the extensor pollicis longus, the flexor digitorum profundus of the index finger, and the extensor digitorum communis were 0.35% (10 patients), 0.29% (8 patients), 0.04% (1 patient), and 0.04% (1 patient), respectively.

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Section: Discussionmentioning

confidence: 99%

Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases

Sato

Murakami

Mimata

et al. 2018

Journal of Orthopaedics

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show abstract

“…Yamazaki et al. reported a risk assessment for tendon rupture after VLP surgery using audible crepitus [19]. They concluded that crepitus and volar placement of the implant were risk factors for tendon attrition after VLP surgery.…”

Section: Discussionmentioning

confidence: 99%

Volar locking plates not touching the flexor pollicis longus tendon appear as prominences on radiographs: a cadaver study

et al. 2019

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Background Plate protrusion is a risk factor for flexor pollicis longus (FPL) rupture following volar locking plate (VLP) surgery. However, plate prominence on follow-up radiographs is common. We hypothesised that a VLP that does not touch the FPL tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs. Materials and methods We studied six current designs of widely used plates in formalin-fixed cadavers. Each plate was placed in six cadavers. We analysed 36 different plate–cadaver combinations. The main aim of plate fixation was to position the plate in the most distal position without FPL tendon contact. Radiographs were obtained using fluoroscopy. We evaluated plate prominence from the volar ridge according to the Soong grading system. Results Soong grades 0 (plate did not extend beyond volar ridge), 1 (plate protruded beyond volar ridge) and 2 (plate directly on or located beyond the volar ridge) were observed in 23 (63.9%), 9 (25.0%) and 4 (11.1%) cadavers, respectively. VariAx, DVR and VALCP showed grade 1 prominence, whereas Acu-Loc2, HYBRIX and MODE showed grade 2 prominence. Conclusions Implant protrusion was observed in 36% of plate–cadaver combinations, even if the plate did not touch the FPL. Estimating the risk of FPL rupture using lateral radiographs alone is likely insufficient. Our findings can be applied to accurately identify the presence of implant prominence following VLP surgery.

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“…Kadoma et al also advocated that ultrasonography could be used to identify the type of intermediate tissue between the FPL tendon and the volar locking plate, suggesting that ultrasonography has the potential to predict the risk of attenuation of the FPL tendon [9]. On the other hand, Yamazaki et al described that sonography might be difficult to employ as a diagnostic tool to judge the risk for flexor tendon attrition, but that a subdermal crepitus sound during thumb movement was an independent risk factor for flexor tendon attrition [18].…”

Section: Discussionmentioning

confidence: 99%

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

et al. 2018

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Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.

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Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study

Cited by 17 publications

References 32 publications

Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases

Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases

Volar locking plates not touching the flexor pollicis longus tendon appear as prominences on radiographs: a cadaver study

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

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