The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Panu H. Nordback 1
Ellen Y. Lee 2
Jin Xi Lim 2
Aymeric YT Lim 2
Soumen Das De 2
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
Keywords
Distal radius fracture
Flexor pollicis longus
Flexor tendon rupture
Tendon reconstruction
Volar locking plate fixation
Subjects
  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006; 37(8):691-7. doi: 10.1016/j.injury.2006.04.130.
  2. Ponkilainen V, Kuitunen I, Liukkonen R, Vaajala M, Reito A, Uimonen M. The incidence of musculoskeletal injuries: a systematic review and meta-analysis. Bone Joint Res. 2022; 11(11):814-825. doi: 10.1302/2046-3758.1111.BJR-2022-0181.R1.
  3. Raudasoja L, Aspinen S, Vastamäki H, Ryhänen J, Hulkkonen S. Epidemiology and Treatment of Distal Radius Fractures in Finland-A Nationwide Register Study. J Clin Med. 2022; 11(10):2851. doi: 10.3390/jcm11102851.
  4. Ghafoori H, Kazemi M, Ghorbani S. Investigation of the History of Distal Radius Fractures in Patients Over 55 Years Old Suffering from Hip Fractures. Arch Bone Jt Surg. 2024; 12(6):418-422. doi: 10.22038/ABJS.2023.75188.3477.
  5. Kamal RN, Shapiro LM. American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand Clinical Practice Guideline Summary Management of Distal Radius Fractures. J Am Acad Orthop Surg. 2022 15; 30(4):e480-e486. doi: 10.5435/JAAOS-D-21-00719.
  6. Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013; 5(3):209-13. doi: 10.1111/os.12045.
  7. Oldrini LM, Feltri P, Albanese J, Lucchina S, Filardo G, Candrian C. Volar locking plate vs cast immobilization for distal radius fractures: a systematic review and meta-analysis. EFORT Open Rev. 2022 19; 7(9):644-652. doi:

 

       10.1530/EOR-22-0022.

  1. Ochen Y, Peek J, van der Velde D, et al. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis. JAMA Netw Open.
  2. Lee JH, Lee JK, Park JS, et al. Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: A multicentre retrospective study. Int Orthop. 2020; 44(10):2057-2067. doi: 10.1007/s00264-020-04673-z.
  3. Yamamoto M, Fujihara Y, Fujihara N, Hirata H. A systematic review of volar locking plate removal after distal radius fracture. Injury. 2017; 48(12):2650-2656. doi: 10.1016/j.injury.2017.10.010.
  4. Cronin PK, Watkins IT, Riedel M, Kaiser PB, Kwon JY. Implant Removal Matrix for the upper Extremity Orthopedic Surgeon. Arch Bone Jt Surg. 2020; 8(1):99-111. doi: 10.22038/abjs.2019.36525.1962.
  5. Azzi AJ, Aldekhayel S, Boehm KS, Zadeh T. Tendon rupture and tenosynovitis following internal fixation of distal radius fractures: a systematic review. 2017; 139(3):717e-724e. doi: 10.1097/PRS.0000000000003076.
  6. Floquet A, Druart T, Lavantes P, Vendeuvre T, Delaveau A. Flexor tendon rupture after volar plating of distal radius fracture: A systematic review of the literature. Hand Surg Rehabil. 2021; 40(5):535-546. doi: 10.1016/j.hansur.2021.05.008.
  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(4):328-35. doi: 10.2106/JBJS.J.00193.
  8. 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(4):549-51.
  9. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma. 2007; 21(10 Suppl):S1–133. doi: 10.1097/00005131-200711101-00001.
  10. Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003; 27(1):1-6. doi: 10.1007/s00264-002-0393-x.
  11. Vasara H, Tarkiainen P, Stenroos A, et al. Higher Soong grade predicts flexor tendon issues after volar plating of distal radius fractures - a retrospective cohort study. BMC Musculoskelet Disord. 2023 10; 24(1):271. doi: 10.1186/s12891-023-06313-0.
  12. Marimuthu R, Jaiswal P, Mani GV. Volar plates on distal radius may cause late rupture of flexor pollicis longus. Injury Extra. 2006; 37(1):1-3.
  13. Adham MN, Porembski M, Adham C. Flexor tendon problems after volar plate fixation of distal radius fractures. Hand (N Y). 2009; 4(4):406-9. doi: 10.1007/s11552-009-9180-0.
  14. Ateschrang A, Stuby F, Werdin F, Schaller HE, Weise K, Albrecht D. Flexor tendon irritations after locked plate fixation of the distal radius with the 3.5 mm T-plate: identification of risk factors. Zeitschrift fur Orthopadie und Unfallchirurgie. 2010; 148(3):319-25.
  15. 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(4):325-8. doi: 10.4055/cios.2012.4.4.325.
  16. Koo SC, Ho ST. Delayed rupture of flexor pollicis longus tendon after volar plating of the distal radius. Hand Surg. 2006; 11(1-2):67-70. doi: 10.1142/S0218810406003048.
  17. Honoki K, Nishida K, Che YH, et al. The sole rupture of flexor digitorum tendons to the index finger following volar locking plate fixation of distal radius fracture: a case report. Trauma Case Rep. 2020:30:100369. doi: 10.1016/j.tcr.2020.100369.

 

 

 

 

 



 

 

 

 

 

 

 

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

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