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Introduction: The purpose of our study was to evaluate the incidence and characterize the types of complications that occur with locked volar plating of distal radius fractures at one institution.

Methods: We retrospectively reviewed the records of 153 randomly selected adult patients with distal radius fractures treated by volar locked plating at one institution from 2001-2009. We identified those patients with minor or major complications. Major complications included hardware-related problems (intra-articular, loosening, pain), tendon rupture or irritation, carpal tunnel syndrome requiring release, infection requiring reoperation, major medical complications and non-union. We identified all other complications as minor complications.

Results: There were 16 major and 27 minor complications for a total of 43 complications (28%). The breakdown of complications is seen in Figure 1. Of the 43 patients with complications, 14 underwent further surgery which included 6 limited or full hardware removal, 1 extensor pollicus longus (EPL) reconstruction, 1 EPL rerouting, 1 open carpal tunnel release, 1 trigger finger release, 1 pin removal. One patient had a Darrach procedure and carpal tunnel release followed by plate removal. Two patients had triangular fibrocartilage complex reconstructions in addition to plate removal. Two patients had intra-articular hardware but declined surgery for removal as they were asymptomatic.

Discussion and Conclusion: The incidence of complications in this study was 43/153 or 28%. The most common complication seen in our series of patients was sensory disturbances (17/43) followed by hardware-related problems (9/43). All but 2 patients had resolution of their sensory disturbances at the time of final follow-up. Tendon-related complications accounted for 4/43 of the total complications. While many of the complications we reported were minor, there was still a relatively high rate of secondary operations (14/153 or 9%). Interestingly, there were no flexor tendon ruptures/irritation as has been documented by others as a complication of volar plating.

Figure 1: Complications by Category