Abstract
Background Flexor tendon irritation or rupture following open reduction and volar plate fixation
of distal radius fractures can cause significant morbidity and necessitate additional
surgical intervention.
Objectives To compare the impact of the extended flexor carpi radialis (e-FCR) and standard
flexor carpi radialis (FCR) approaches on contact pressures between the flexor tendons
and volar distal radius plates.
Methods Eight matched pairs of fresh frozen cadavers had each limb randomized to undergo
either the e-FCR or standard FCR approach. After the approach, a locking plate was
applied to the volar distal radius more distally than ideally to create a worst-case
scenario for the digital flexor tendons. Electronic pressure sensors were secured
to the volar aspect of each locking plate. Each wrist was pinned in 20 degrees of
extension during testing. Using a computer-controlled stepper motor system attached
to the digital flexor and extensor tendons, the digits were taken through 4,000 cycles
simulating 12 weeks of active flexion and extension.
Results There were no statistically or clinically significant differences when comparing
the contact pressures of the e-FCR approach with the standard FCR approach at any
time intervals. The e-FCR had statistically significantly higher radial-sided contact
pressures than ulnar-sided contact pressures during early-to-intermediate testing
intervals. These differences resolved at late and final testing intervals.
Conclusions When comparing the standard FCR approach with the e-FCR approach, with the wrist
in 20 degrees of extension, there is no significant difference in contact pressures
that occur between the digital flexor tendons and volar distal radius plates.
Clinical Relevance Further study and technique modifications may eventually lead to better methods of
avoiding flexor tendon rupture during the volar plating of distal radius fractures.
Keywords
carpal tunnel - distal radius - fracture - tendon rupture - wrist approach
