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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Complications of Volar Plating Using Standardized Surgical Technique
Jorge Luis Orbay, MD1; Francisco Rubio, MD1; Eric Balaguer, MD2; C. Edward Hoffler, MD, PhD3 Lauren Vernon, PhD1
1The Miami Hand and Upper Extremity Institute, Miami, FL; 2The Miami Hand & Upper Extremity Institute, Miami, FL; 3Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Introduction Distal radius fractures (DRFs) are one of the most frequent injuries of the upper extremity. Volar locking plate fixation has become the most popular treatment; unfortunately, some series have reported patient reported complication rates up to 21% and physician reported complication rates of 27% [1]. We believe that surgical technique is most important in limiting complications. We are a group of four fellowship trained hand surgeons who all routinely use the extended flexor carpi radialis (EFCR) approach [2]. We believe that with proper technique, the complication rate can be lower than reported in the literature.

Materials & Methods We conducted a retrospective review of 808 consecutive patients treated with a volar locking plate using the EFCR over a 4 year period. Patients were asked to complete a survey to evaluate satisfaction (0-10) and report and comment on their complications. Infection and complications requiring revision surgery were considered major complications. Patient questionnaires, medical records and x-rays were reviewed to evaluate complications.

Results Out of 808 total patients, 443 patients completed our survey (54.8%); 21 (2.5%) were deceased; 86 (10.6%) changed their contact information; 4 (<0.5%) declined to participate, and the rest were unable to be reached. Patients rated their satisfaction with the outcome of their wrist surgery as a 9.14 out of 10. Of the 443 patients who completed the study, 41 (9.3%) reported a complication. These complications ranges from bruising or pain that resolved with time to tendon rupture, re-operation, and infection. There were 21 major complications (4.7%), including two patients who developed an infection requiring antibiotics (<0.5%), and 19 revision procedures (4.3%) including 5 hardware removals and 1 tendon rupture (<0.25%).

Conclusions A 4.7% complication rate and 0.25% incidence of tendon rupture is lower than complications reported by other series. We believe our lower complication rates are related to our standardized surgical technique and surgeon experience.

[1] S. D. Mckay, J. C. MacDermid, J. H. Roth and R. S. Richards, "Assessment of complications of distal radius fractures and development of a complications checklist," J Hand Surg, vol. 26A, no. 5, pp. 916-922, September 2001.

[2] J. L. Orbay, A. Badia, I. R. Indriago, A. Infante, R. K. Khouri, E. Gonzalez and D. L. Fernandez, "The Extended Flexor Carpi Radialis Approach: A New Perspective for the Distal Radius Fracture," Tech Hand Surg, vol. 5, no. 4, pp. 204-211, 2001.


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