Volume 9 Supplement 3

10th Congress of the Asia-Pacific Federation of Societies of Surgery of the Hand and the 6th Congress of the Asia-Pacific Federation of Societies of Hand Therapists

Open Access

Avoiding complication of volar locked plates

  • Marcos Sanmartin Fernandez1
BMC Proceedings20159(Suppl 3):A42

https://doi.org/10.1186/1753-6561-9-S3-A42

Published: 19 May 2015

Volar locking plates are designed to improve and maintain anatomic alignment, even in patients with dorsal comminution and poor metaphyseal bone quality. Its widespread use led to specific complications. Most part is related to tendon, nerve and complex regional pain syndrome [1] and could be avoided by meticulous attention to detail and surgical experience [2].

Tendon and articular injury complications can be prevented by careful avoidance of dorsal cortex and intraarticular screw penetration, use of the low profile plates, and careful placement of the plate proximal to the watershed line.

Most frequent tendons affected are Extensor Policis Longus (EPL) and Flexor Policis Longus (FPL). EPL tendon rupture can occur after a distal radius fractures even when not fixed by a plate [3].

Use of standard intraoperative fluoroscopy imaging is crucial to assess dorsal cortex screw penetration. Lister tubercle can mask prominent screws tips and lateral images have limited sensibility particularly among less experienced observers and for the evaluation of the most ulnar screw positions [4].

Irritation or rupture of flexor tendons, especially the FPL, depends on the position of the plate [5].

Assessment of articular penetration of the screws is critical. Routine use of articular views [6], as well as a 45° pronated oblique view [7] in doubtful cases, is mandatory during placement of each screw.

Postoperative nerve dysfunction is one of the most common complications, especially median nerve dysfunction [1].

K-wires used for provisional and supplementary fixation can be a source of complications. Such complication may be caused by superficial radial nerve irritation due to K-wire placement during fracture reduction.

Finally, loss of reduction due to inadequate screw length or very osteoporotic bone may lead to symptomatic malunion. In extra-articular fractures, a minimum of four locked unicortical distal screws [8] of at least 75% length produce construct stiffness similar to bicortical fixation and should be considered to avoid extensor tendon injury [9]. This is not the case when there are dorsal unstable articular fragments that can displace afterwards.

Once the fracture is healed, plates and screws are not necessary anymore and their removal can be indicated or suggested as a prophylactic measure, as this procedure is usually not associated with complications [10].

Authors’ Affiliations

(1)
Department of Orthopaedics and Traumatology, Hospital Povisa

References

  1. Bentohami K, de Burlet K, de Korte N, van den Bekerom MPJ, Goslings JC, Schep NWL: Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur. 2014, 39 (7): 745-754. 10.1177/1753193413511936.View ArticleGoogle Scholar
  2. Ward CM, Kuhl TL, Adams BD: Early complications of volar plating after distal radius fractures and their relationship to surgeon experience. Hand. 2011, 6 (2): 185-189. 10.1007/s11552-010-9313-5.PubMedPubMed CentralView ArticleGoogle Scholar
  3. Bonatz E, Kramer TD, Masear VR: Rupture of the extensor pollicis longus tendon. Am J Orthop (Belle Mead NJ). 1996, 25 (2): 118-122.Google Scholar
  4. Thomas A, Greenberg J: Use of Fluoroscopy in Determining Screw Overshoot in the Dorsal Distal Radius: A Cadaveric Study. J Hand Surg. 2009, 34A (2): 258-261.View ArticleGoogle Scholar
  5. Kitay A, Swanstrom M, Schreiber JJ, Carlson MG, Nguyen JT, Weiland AJ, Daluiski A: Volar Plate Position and Flexor Tendon Rupture Following Distal Radius Fracture Fixation. J Hand Surg. 2013, 38 (6): 1091-1096. 10.1016/j.jhsa.2013.03.011.View ArticleGoogle Scholar
  6. Pace A, Cresswell T: Use of Articular Wrist Views to Assess Intra-Articular Screw Penetration in Surgical Fixation of Distal Radius Fractures. J Hand Surg. 2010, 35 (6): 1015-1018. 10.1016/j.jhsa.2010.03.041.View ArticleGoogle Scholar
  7. Smith DW, Henry MH: The 45-degree pronated oblique view for volar fixed angle plating of distal radius fractures. J Hand Surg. 2004, 29 (4): 703-706. 10.1016/j.jhsa.2004.04.006.View ArticleGoogle Scholar
  8. Mehling M, Müller LP, Delinsky K, Mehler D, Burkhart KJ, Rommens PM: Number and Locations of Screw Fixation for Volar Fixed-Angle Plating of Distal Radius Fractures: Biomechanical Study. J Hand Surg. 2010, 35 (6): 885-891. 10.1016/j.jhsa.2010.03.027.View ArticleGoogle Scholar
  9. Wall LB, Brodt MD, Silva MJ, Boyer MI, Calfee RP: The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed With Volar Locking Plates. J Hand Surg. 2012, 37 (3): 446-453. 10.1016/j.jhsa.2011.12.013.View ArticleGoogle Scholar
  10. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A: Removal of Locked Volar Plates After Distal Radius Fractures. J Hand Surg. 2011, 36 (6): 982-985. 10.1016/j.jhsa.2011.03.032.View ArticleGoogle Scholar

Copyright

© Fernandez; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement