The Incidence of FPL Rupture in Distal Radius Fractures Treated with Volar Locking Plate Fixation
Alyssa N Cook, BA; Paul Baldwin, MD; John R. Fowler, MD
University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Distal radius fractures are the most common upper extremity fracture. Unstable fractures are often treated with open reduction and internal fixation (ORIF) using volar locking plate (VLP) fixation. Flexor pollicus longus (FPL) rupture and flexor tendon irritation are noted complications associated with VLP fixation. One proposed mechanism for these complications is prominence of the VLP secondary to plate design and/or placement. Complication rates of FPL rupture following distal radius ORIF are not well-defined for a large population and there is a paucity of recent studies.
Purpose: To evaluate post-ORIF FPL rupture and complication rates relative to Soong grade and to assess FPL rupture and complication rates overall in a large series of patients. The null hypotheses are that there is no difference in the rates of post-ORIF FPL rupture between Soong grades and there is no difference in FPL rupture rate when comparing plate designs.
Methods: A retrospective review was performed from January 2012 to December 2015. Subjects identified using CPT codes (25607, 25608, and 25609). Chart reviews were performed on 750 patients. Exclusion criteria were lack of VLP fixation, lack of post-operation follow-up, lack of available imaging and use of external fixation. Complications (tendon rupture, tenosynovitis, plate removal, CRPS, stiffness, persistent pain) were assessed at each post-operative visit. A hand-fellowship trained orthopaedic surgeon determined Soong grade. Data was collected on patients' age, injury date, operation date, plate type, and gender. T-tests were used to assess statistical significance.
Results: A total of 533 subjects met inclusion criteria (365 females, 168 males) with a mean age of 53. Flexor tenosynovitis was the most common complication (24%). No FPL ruptures occurred. Patients with complications averaged 52 years of age compared to 54 years of age in patients without complications, (p=0.31). Complication rates were not significantly different between genders. In both patients with and without complications, the mean time from injury to surgery was 5 days (p=0.96). Complication rates were not significantly different between fixation performed by upper extremity orthopedists (8.18%) and orthopedic trauma surgeons (8.16%) (p=0.99). Soong grades between patients with and without complications were not significantly different (p=0.53).
Discussion: In this series of 533 distal radius fractures that underwent ORIF with VLP, there were no FPL ruptures. The lack of FPL ruptures in this large series may reflect improved plate design technology and increased awareness regarding this complication.
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