Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

Abstract

Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures.

Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon.

Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon.

Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033).

Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection.

Level of Evidence This is Level IV study.

Keywords

flexor pollicis longus - distal radius fracture - tendon rupture - Soong classification - ultrasound

Note

Institutional review board approval was granted by means of a general waiver for studies with retrospective data analysis (local research ethics committee, Medical University Innsbruck, February 20, 2009).

• References

• 1 Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003; 27 (01) 1-6
• 2 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
• 3 Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol 2009; 34 (04) 471-474
• 4 Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 2010; 68 (04) 992-998
• 5 Monda MK, Ellis A, Karmani S. Late rupture of flexor pollicis longus tendon 10 years after volar buttress plate fixation of a distal radius fracture: a case report. Acta Orthop Belg 2010; 76 (04) 549-551
• 6 Kadoma C, Takahara M, Maruyama M, Satake H, Takagi M. Ultrasonographic assessment of the flexor pollicis longus tendon after plate fixation. Orthopedics 2017; 40 (01) e104-e108
• 7 Selvan DR, Machin DG, Perry D, Simpson C, Thorpe P, Brown DJ. The role of fracture reduction and plate position in the aetiology of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures. Hand (N Y) 2015; 10 (03) 497-502
• 8 Limthongthang R, Bachoura A, Jacoby SM, Osterman AL. Distal radius volar locking plate design and associated vulnerability of the flexor pollicis longus. J Hand Surg Am 2014; 39 (05) 852-860
• 9 Asadollahi S, Keith PP. Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthop Traumatol 2013; 14 (04) 227-234
• 10 Kitay A, Swanstrom M, Schreiber JJ. , et al. Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am 2013; 38 (06) 1091-1096
• 11 Kara A, Celik H, Bankaoglu M, Oc Y, Bulbul M, Sugun TS. Ultrasonic evaluation of the flexor pollicis longus tendon following volar plate fixation for distal radius fractures. J Hand Surg Am 2016; 41 (03) 374-380
• 12 Oura K, Oka K, Kawanishi Y, Sugamoto K, Yoshikawa H, Murase T. Volar morphology of the distal radius in axial planes: a quantitative analysis. J Orthop Res 2015; 33 (04) 496-503
• 13 Nanno M, Kodera N, Tomori Y, Takai S. Transverse ultrasound assessment of the flexor pollicis longus tendon movement on the distal radius during wrist and finger motion in distal radius fracture with volar plating. J Med Ultrason (2001) 2016; 43 (01) 29-36
• 14 Schlickum L, Quadlbauer S, Pezzei C, Stophasius E, Hausner T, Leixnering M. Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg 2019; 139 (02) 269-279
• 15 Agnew SP, Ljungquist KL, Huang JI. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am 2015; 40 (06) 1102-1105
• 16 Nelitz M. Femoral derotational osteotomies. Curr Rev Musculoskelet Med 2018; 11 (02) 272-279
• 17 Nanno M, Kodera N, Tomori Y, Takai S. Ultrasonographic movement of the flexor pollicis longus tendon before and after removal of a volar plate for the distal radius fracture. J Orthop Surg (Hong Kong) 2018; 26 (01) 2309499018760131