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Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate
15 August 2019
07 January 2020
18 March 2020 (online)
Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture.
Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture.
Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury.
Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication.
Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.
- 1 Protopsaltis TS, Ruch DS. Volar approach to distal radius fractures. J Hand Surg Am 2008; 33 (06) 958-965
- 2 Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (08) 1837-1846
- 3 McKay SD, MacDermid JC, Roth JH, Richards RS. Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 2001; 26 (05) 916-922
- 4 Mathews AL, Chung KC. Management of complications of distal radius fractures. Hand Clin 2015; 31 (02) 205-215
- 5 Cho CH, Lee KJ, Song KS, Bae KC. Delayed rupture of flexor pollicis longus after volar plating for a distal radius fracture. Clin Orthop Surg 2012; 4 (04) 325-328
- 6 Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 2011; 36 (01) 3-9
- 7 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (04) 328-335
- 8 Louis DS. Prospective multi-center trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am 1998; 23 (02) 353-354
- 9 Orbay J. Volar plate fixation of distal radius fractures. Hand Clin 2005; 21 (03) 347-354
- 10 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (05) 316-322
- 11 Bell JS, Wollstein R, Citron ND. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br 1998; 80 (02) 225-226
- 12 Duncan SF, Weiland AJ. Delayed rupture of the flexor pollicis longus tendon after routine volar placement of a T-plate on the distal radius. Am J Orthop 2007; 36 (12) 669-670
- 13 Brown EN, Lifchez SD. Flexor pollicis longus tendon rupture after volar plating of a distal radius fracture: pronator quadratus plate coverage may not adequately protect tendons. Eplasty 2011; 11: e43
- 14 Douthit JD. Volar plating of dorsally comminuted fractures of the distal radius: a 6-year study. Am J Orthop 2005; 34 (03) 140-147
- 15 Berger P, Duerinckx J. Flexor pollicis longus tendon rupture after volar wrist plating: Reconstrution with palmaris longus interposition graft. Acta Orthop Belg 2017; 83 (03) 467-472
- 16 Sügün TS, Karabay N, Gürbüz Y, Ozaksar K, Toros T, Kayalar M. Screw prominences related to palmar locking plating of distal radius. J Hand Surg Eur Vol 2011; 36 (04) 320-324
- 17 Selvan DR, Perry D, Machin DG, Brown DJ. The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures - a case control study. Injury 2014; 45 (12) 1885-1888