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Complications of Volar Locked Plating for Distal Radius Fractures
Hillary Ann Becker, MD; David Micah Brogan, MD; Ashley Walker; David Gary Dennison; Alexander Y. Shin;
Mayo Clinic

Introduction: The purpose of this study was to evaluate the incidence and characterize the complications of locked volar plating of distal radius fractures

Methods: A retrospective review of all adult patients with distal radius fractures treated with volar locked plating at a single institution between 2001-2009 was undertaken. 596 wrists in 585 patients were included in the analysis. Major complications included: hardware-related problems; tendon rupture or irritation; carpal tunnel syndrome requiring release or compartment syndrome requiring reoperation; DRUJ instability requiring reoperation; major medical complications; post-traumatic arthritis requiring wrist fusion; arterial injuries and mal-union. We identified all other complications as minor complications.

Results: The average age was 56.5 years, with a F:M ratio of 3.1:1 . Average follow-up was just over 8 months. We identified a total of 85 major and 100 minor complications for a total of 185 complications sustained by 155 patients (26%). The types of complications observed are listed in Figure 1. Of the 155 patients with complications, 29 had symptomatic hardware removed, 3 had EPL ruptures and 1 an FPL rupture. Carpal tunnel syndrome requiring surgical intervention was diagnosed in the immediate post-operative period (within the first 3 months of surgery) in 11 patients. One of these required a return to the operating room within 5 days of the index surgery, the rest were observed for a period of weeks or months and eventually returned to the OR on an elective basis.

Conclusion/Discussion: At least one major or minor complication occurred in 26% of patients undergoing volar locked plating. The most common of these were sensory disturbances (9.7%) followed by hardware-related problems (6.3%). After hardware removal, carpal tunnel release was the second most common reason for return to the operating room, with all but one of these performed as an elective procedure. The rate of major medical complications, while overall very low, did include one death in the immediate post-operative period as well as one non-fatal massive pulmonary embolism. The overall rate of tendon related problems was also very low (2.0%) with EPL rupture noted in 3 patients, along with a single FPL rupture.

Summary: We found 185 complications in a review of 596 wrists treated with volar locked plating for distal radius fractures at one institution. The majority of these complications were minor sensory neurapraxias which resolved, but painful hardware requiring removal was observed with some frequency.

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