Tendon Rupture After Volar Plating of Distal Radius Fracture (original) (raw)
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Flexor Pollicis Tendon Rupture After Volar Plating of Distal Radius Fracture
Journal of Orthopaedics and Sports Medicine , 2020
Introduction: Distal radius fractures are one of the commonest fractures seen worldwide with a steadily rising incidence. There are numerous treatment options available for their management with the most recent advancement being the use of volar locking plates. These locking plates despite advancement in their design and biomechanical construct have been shown to result in flexor tendon rupture and tenosynovitis in up to 15% of patients. Case Report: A 70-year-old female underwent open reduction and internal fixation with a 3.5 mm volar locking plate for the treatment of a right intra-articular distal radius fracture with volar displacement. Twenty-six (26) months after the initial procedure she represented with the inability to flex her thumb after reaching for an object one month prior. The patient subsequently underwent surgical exploration to address her FPL tendon rupture with reconstruction utilising ipsilateral palmaris longus graft with a Pulvertaft weave for both proximal and distal anastomoses. Conclusion: The reconstruction technique employed in this case yielded a good functional outcome for this patient. The pulvertaft weave as a proximal and distal anastomosis suture provides a good option for reconstruction once there is sufficient graft length to permit its use on both ends.
Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases
Chirurgie de la Main, 2010
We report three cases of complete rupture of the flexor pollicis longus (FPL) tendon, one case of complete rupture of the index and middle finger flexor digitorum profundus tendons and one case of rupture of the flexor digitorum profundus tendon to the index finger after placement of a volar plate for distal radius fracture. We review the literature and discuss the aetiology of tendon ruptures and techniques to prevent tendon attition. #
Distal radius fractures: strategic alternatives to volar plate fixation
Instructional course lectures, 2014
Volar locking plates have provided surgeons with enhanced capability to reliably repair both simple and complex fractures and avoid the hardware-related complications associated with dorsal plating. However, there have been an increasing number of published reports on the frequency and types of complications and failures associated with volar locked plating of distal radius fractures. An informed, critical assessment of distal radius fracture characteristics will allow surgeons to select an individualized treatment strategy that maximizes the likelihood of a successful outcome. Knowledge of the anatomy, patterns, and characteristics of the diverse types of distal radius fractures and the complications and failures associated with volar locked plating will be helpful to orthopaedic surgeons who treat patients with these injuries.
2022
Introduction: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants. Materials and methods: A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.
Research Square (Research Square), 2021
The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to exor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, ultradistal radius fracture patterns required the plate to cross the watershed line, making con ict over plate positioning on ultra-distal radius fractures. This study compared functional outcomes in patients with ultra-distal radius fractures treated with two different implants. Materials and Methods: A retrospective study was conducted, all patients who received a Synthes 2.4mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The ultra-distal fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and gripping strengths (P = 0.014) were signi cantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also signi cantly better (P = 0.006). Conclusions: Despite advances in implant designs, exor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures. distal then watershed line is inevitable, such as the ultra-distal fracture pattern in this study. In choosing the Acumed Acu-Loc VLP and carefully tting it to the anatomy of the distal radius, we believe this generates better outcomes when compared with the Synthes 2.4 mm LCP. Study limitations Our study had several limitations. It was retrospective in nature, therefore patients were not randomized, and hand-surgeon implant prevalence and operational techniques were not be standardized. The primary outcomes were based on patient report outcomes (PROs), and potentially limit objectivity, as patient expectations and compliance may have in uenced the outcomes, besides implant selection. Patient numbers were relatively low, however we must also account for the relatively low incidence of ultra-distal radius fracture patterns, therefore we believe our cohort size was appropriate and acceptable. The minimal follow-up period was 24 months post-operation, and was considered adequate in capturing bone healing indices, however some delayed complications may not have been fully ascertained. Asadollahi et al. reported that delayed exor tendon rupture could occur anywhere between 4 and 68 months, post-operation (20). Conclusions Despite advances in implant designs, exor tendon irritation or rupture is still a serious complication following distal radius VLP ORIF. Avoid placing the VLP distal than the watershed line and reduced the volar prominence of the implant on lateral view are commonly suggested. But ultra-distal or comminuted intraarticular fracture patterns require more distal xation, and placing the implant more distal to the watershed line is inevitable. We believe the Acumed Acu-Loc VLP design provided better functional outcomes when compared with the Synthes 2.4 mm LCP, if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures.
Background: Distal end radius fracture is one of the most common upper extremity fracture. Intraarticular distal end of radius fracture is a therapeutic challenge. They can be managed by various treatment modalities. The function outcome of a particular treatment modality needs to be further studied. Objectives: To evaluate the functional outcome and complications of intraarticular distal radius fracture treated by volar locking plate fixation. Methods: Prospective study involving Adults (18-60years) with intraarticular distal radius fracture admitted to a Tertiary care center in Kerala,India in the period from February 2016 to July 2017. In this study 35 patients with intraarticular distal radius fracture selected by consecutive sampling were treated with volar locking plate. Serial follow up was done at 4, 8, 12, 24 weeks using QuickDASH , PRWE questionnaire and xrays to assess radiological union and complications. Results: At 24 weeks follow up mean QuickDASH score was 6.82±7.84 and mean PRWE score was 14.56±6.77 with good functional outcome. Radiological union was noted in majority (28 cases) by 8 weeks. Wrist stiffness was noted in 5 cases. There were no cases of Intra articular screw penetration, Screw loosening, Non-union, Implant failure, Shoulder hand syndrome or neuropathies. Conclusion: Volar locked plating may be recommended for intraarticular distal radius fractures requiring operative intervention with early mobilization of wrist joint.
Journal of wrist surgery, 2017
Background Distal radius fractures are very common and an increased incidence of 50% is estimated by 2030. Therefore, both operative and postsurgical treatment remains pertinent. Main aim in treating intra-articular fractures is to restore the articular surface by internal fixation and early mobilization (EM). Questions/Purposes The purpose of this study was to compare functional results between EM immediately after surgery and 5 weeks of immobilization (IM). Patients and Methods In a randomized prospective study, 30 patients with an isolated distal radius fracture were treated by open reduction and internal fixation using a single volar locking plate excluding bone graft. Fifteen patients were randomized in the EM group and 15 in the IM group. At 6 weeks, 9 weeks, 3 months, 6 months, and 1 year postsurgery, range of motion, grip strength and X-rays were evaluated. Additionally, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-Rated Wrist Evaluation ...
Advances in orthopedics, 2011
Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year...