Purpose of the study: Volar plate fixation is becoming increasingly popular for instable fractures of the distal radius or on porotic bone. We report our experience and unavoidable or predictable complications with this type of fixation.
Material and methods: The 142 patients who underwent surgery from 2006 to 208 were reviewed and followed prospectively. In 2006 and 200, three types of volar plates were implanted: the Ace Depuy (standard), the T or DRP (Synthes), prolock with locking screws, (ITS) with a series of 104 patients. In 2008, two types of new generation plates with a more anatomic design were used: Variax (Stryker) and Newclip with a series of 48 patients. Complications were noted with minimum four months follow-up.
Results: All fractures healed. The Herzberg score reached 81/100 and the DASH 19.4. The complication rate was 19% (n=19) for the older generation plates and 15% (n=7) for the new anatomic plates. The main complications were tears of the long flexor and long extensor pollicis tendons (two before 2008 and four after 2008), reflex dystrophy (five before 2008 and two after), carpal tunnel syndrome (n=4), and material problems (dislodged screw, protruding screw) with no functional consequences (six before 2008 and one after).
Discussion: The increasing popularity of plate fixation for distal radius fractures generates an increase in complications. These are predictable if the material protrudes (tendon tears caused by overly long screws). Three published series on these specific complications (Rozental 2006, Rampoldi and Arora 2007) found that these problems could be avoided, both by implant design and by surgical technique. Locking the epiphyseal screws requires insertion into the subchondral bone and thus distal implantation of the plates, generating an iatrogenic conflict for the flexors. The rediscovery of the anatomy of the distal radius should help avoid styloid problems, and reconsideration of plate design to avoid advancement both on the ulnar side and the radial side. While the extra-articular volar plates fulfil the same function as pinning (Obert 2006), plates have lower indirect costs than pinning + plaster cast (Candelier 2006). Conversely, there is still no proof of the superiority of locked screws over standard screws.
