Risk for Flexor Pollicis Longus Rupture after Volar Lock Plating for Distal Radius Fracture Lasts Over a Decade

Document Type : RESEARCH PAPER

Authors

1 1 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore 2 Department of Hand Surgery, Bridge Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

2 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore

10.22038/abjs.2024.77674.3587

Abstract

Objectives: Volar locking plate (VLP) fixation is a very common procedure due to the high incidence of 
distal radius fractures (DRFs). Attritional flexor tendon rupture is a rare, but recognized complication 
after VLP fixation. There is no current consensus to prevent the condition. Our objective was to highlight 
the long-term risk for flexor tendon rupture after VLP fixation.
Methods: We conducted a retrospective single-center review of patients with attritional flexor tendon rupture after 
VLP fixation for DRFs between 2016 and 2021. Patient demographics, DRF details including AO fracture 
classification, Soong grading and tendon reconstruction were collected. Thumb interphalangeal joint (IPJ) motion 
and Kapandji score were used as outcome measures for the tendon reconstruction.
Results: We identified five patients with attritional flexor pollicis longus (FPL) ruptures. The median age of the 
patients at the time of DRF was 48 (34-56) years. All VLP fixations were Soong grade 2. Median time from VLP 
fixation to tendon rupture was 7 (3-14) years. Longest surgery-to-rupture interval was 14 years. One rupture was 
treated conservatively. Four were reconstructed using palmaris longus (PL) tendon graft. Thumb IPJ active range 
of motion median was 48 (20-55) degrees and Kapandji score 9/10 (7-9/10).
Conclusion: Older generation VLP fixations with Soong grade 2 pose a long-term risk for attritional FPL rupture, 
which can be reconstructed with PL tendon graft with fair to good outcomes.
 Level of evidence: IV

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The Archives of Bone and Joint Surgery
Volume 12, Issue 12
December 2024
Pages 835-839

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History

  • Receive Date: 06 February 2024
  • Revise Date: 03 October 2024
  • Accept Date: 05 October 2024

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