RE-OPERATION FOR METALWORK COMPLICATIONS FOLLOWING THE USE OF VOLAR LOCKING PLATES FOR DISTAL RADIUS FRACTURES: EXPERIENCE OF A GENERAL TRAUMA UNIT IN UK

Abstract

Aim: Volar locking plates are increasingly used in the management of distal radius fractures. As with any new implant, understanding the rate and type of potential metalwork related complications is important. The aim of the study was to determine the type and rate of implant related complications that require further surgery when using volar locking plates in the management of distal radius fractures.

Methods: In this study, we reviewed 114 distal radius fractures treated with volar locking plating. Patient records were reviewed with regards to demographics, operative details and post-operative outcomes. Fractures were classified as intra-articular or extra-articular. They were further classified using the AO classification system

Results: In our series, 12 cases (10%) underwent further surgery for metal work related complications mainly for screw protrusion into the radiocarpal joint following fracture collapse. Intra-articular fractures had a significantly greater complication rate as compared to extra-articular ones (11 vs. 1, P=0.04). There was no significant difference between the three plating systems used in this series with regards to need of further surgery (P=0.43). There was no significant difference between the grade of the operating surgeon with regards to metal work complications (P=0.9). There was no difference in rate of complications between males and females (P=0.27). Similarly there was no difference in metal work complications between patients aged less than 60 as compared to those aged more than 60 years (P=0.58). Our study has shown that volar locking plates may be associated with up to 10% rate of metalwork complications requiring revision surgery. The most common (8 out of 12) cause of re-operation was to remove the screws protruding into the radio-carpal joint.

Discussion: Our results suggest that volar locking plates are associated with a high rate of metal work related complications requiring further surgery. In conclusion our study suggests that volar locking plates are associated with high reoperation rates for implant related complications. Intraoperative screening to ensure that there is no intrarticular penetration is also essential. We favour obtaining intra-operatively a lateral view with the forearm elevated 15–20 degrees to the horizontal plane to allow for the medial-lateral radial inclination and taking the posterior-anterior view at about 20 degrees to the horizontal plane to allow for the normal volar distal radial tilt.

We feel that for a common fracture such as distal radial fractures an ideal implant should be easily reproducible with a low complication rate.