Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study

J Hand Surg Am. 2011 Jul;36(7):1135-41. doi: 10.1016/j.jhsa.2011.04.004.

Abstract

Purpose: Dorsal plating of distal radius fractures with traditional 2.5-mm-thick plates is associated with extensor tendon complications. Consequently, volar locking plates have gained widespread acceptance. A new generation of 1.2- to 1.5-mm, low-profile dorsal plates was designed to minimize tendon irritation. This study examines the complication rates of low-profile dorsal plates compared with volar locking plates.

Methods: We identified patients with distal radius fractures treated between September 2002 and June 2006 by low-profile dorsal or volar locking plates. Information pertaining to 7 categories of complications (hardware discomfort and pain, tendon irritation/rupture, failure of reduction, infection, complex regional pain syndrome, stiffness, and neuropathy/hypersensitivity) was collected. Complications were defined as any postoperative plating complications requiring additional surgical intervention, whereas those that only caused patient discomfort were considered secondary problems.

Results: We included 100 patients, comprising 104 plating cases (57 dorsal, 47 volar), in this study. Overall length of follow-up was 44 ± 21 months (range, 12-80 mo). A total of 18 patients (8 dorsal, 10 volar) experienced complications, whereas 47 (25 dorsal, 22 volar) had secondary reports. Three dorsal and 4 volar patients had complete plate removals. Three dorsal and no volar plates had screw removals only. One volar plate (no dorsal plates) had a major tendon rupture (flexor pollicis longus); 3 dorsal and 3 volar plates resulted in tendon irritation complications, and 4 dorsal and 3 volar plates had secondary problems from tendon irritation. None of the above measures approached statistical significance. Volar cases were associated with significantly more neuropathic complications than dorsal cases.

Conclusions: Dorsal low-profile plates are not associated with significantly more tendon irritation or rupture complications. However, volar plating is associated with a higher rate of neuropathic complications.

Type of study/level of evidence: Therapeutic III.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Bone Plates*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / adverse effects*
  • Fracture Fixation, Internal / instrumentation*
  • Fracture Fixation, Internal / methods
  • Fracture Healing / physiology
  • Humans
  • Incidence
  • Injury Severity Score
  • Joint Instability / etiology
  • Joint Instability / prevention & control
  • Male
  • Middle Aged
  • Pain Measurement
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / surgery
  • Prosthesis Design*
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Range of Motion, Articular / physiology
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Treatment Outcome
  • Wrist Injuries / diagnostic imaging
  • Wrist Injuries / surgery
  • Young Adult