Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate

Abstract Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

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Reducing the risk of flexor pollicis longus tendon rupture after volar plate fixation for distal radius fractures: validation of the tendon irritation test

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-014-1420-5 ◽

2014 ◽

Vol 24 (8) ◽

pp. 1425-1429 ◽

Cited By ~ 7

Author(s):

Seigo Suganuma ◽

Kaoru Tada ◽

Hiroyuki Tsuchiya

Keyword(s):

Distal Radius ◽

Tendon Rupture ◽

Plate Fixation ◽

Volar Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Longus Tendon ◽

Irritation Test ◽

Volar Plate Fixation ◽

Flexor Pollicis Longus Tendon

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PREVENTION OF FLEXOR POLLICIS LONGUS TENDON RUPTURE AFTER VOLAR PLATE FIXATION OF DISTAL RADIUS FRACTURES

Hand Surgery ◽

10.1142/s0218810411005539 ◽

2011 ◽

Vol 16 (03) ◽

pp. 271-275 ◽

Cited By ~ 24

Author(s):

Kaoru Tada ◽

Kazuo Ikeda ◽

Kenji Shigemoto ◽

Seigo Suganuma ◽

Hiroyuki Tsuchiya

Keyword(s):

Distal Radius ◽

Tendon Rupture ◽

Plate Fixation ◽

Tendon Injury ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Plate Removal ◽

Volar Plate Fixation ◽

Flexor Pollicis Longus Tendon ◽

Thumb Motion

We evaluated the presence of "tendon irritation" of flexor pollicis longus (FPL) for cases of distal radius fracture treated with volar plates to prevent FPL tendon rupture. This report details cases of 24 patients. The presence of pain or a sense of incompatibility and subdermal crepitus around the wrist with an active thumb motion were defined as symptoms of FPL tendon irritation. Twelve of 24 patients complained of FPL tendon irritation. The plates were removed in nine of these 12 patients, while tendon injury was found in three cases. The other 12 patients did not complain of FPL tendon irritation. Four of these 12 patients underwent plate removal, and tendon injury was not detected. The results of this study indicate that FPL tendon irritation is likely to appear before tendon rupture. Therefore, FPL tendon rupture might be prevented by plate removal in patients who complained of tendon irritation.

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Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture

Hand ◽

10.1177/1558944716668850 ◽

2016 ◽

Vol 12 (3) ◽

pp. NP39-NP42 ◽

Cited By ~ 2

Author(s):

J. Ryan Hill ◽

Ram K. Alluri ◽

Alidad Ghiassi

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Flexor Tendon Rupture ◽

Tendon Laceration

Background: Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures. Methods: A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site. Results: Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant. Conclusions: Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

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The Role of Fracture Reduction and Plate Position in the Aetiology of Flexor Pollicis Longus Tendon Rupture after Volar Plate Fixation of Distal Radius Fractures

Hand ◽

10.1007/s11552-014-9735-6 ◽

2015 ◽

Vol 10 (3) ◽

pp. 497-502 ◽

Cited By ~ 12

Author(s):

David R. Selvan ◽

David G. Machin ◽

Daniel Perry ◽

Claire Simpson ◽

Phillipa Thorpe ◽

...

Keyword(s):

Distal Radius ◽

Tendon Rupture ◽

Plate Fixation ◽

Fracture Reduction ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Longus Tendon ◽

Volar Plate Fixation ◽

Flexor Pollicis Longus Tendon

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Distal Radius Fracture Outcomes and Rehabilitation

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458516669202 ◽

2016 ◽

Vol 7 (4) ◽

pp. 202-205 ◽

Cited By ~ 20

Author(s):

Tochukwu C. Ikpeze ◽

Heather C. Smith ◽

Daniel J. Lee ◽

John C. Elfar

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Hip Fractures ◽

Functional Outcomes ◽

Plate Fixation ◽

Volar Plate ◽

Radius Fracture ◽

Percutaneous Pinning ◽

Radius Fractures ◽

Volar Plate Fixation

Distal radius fractures account for nearly 1 of every 5 fractures in individuals aged 65 or older. Moreover, increased susceptibility to vertebral and hip fractures has been documented in patients a year after suffering a distal radius fracture. Although women are more susceptible to hip fractures, men experience a higher mortality rate in the 7 years following a distal radius fracture. Traditional approaches to distal radius fractures have included both surgical and nonsurgical treatments, with predominant complaints involving weakness, stiffness, and pain. Nonsurgical approaches include immobilization with or without reduction, whereas surgical treatments include dorsal spanning bridge plates, percutaneous pinning, external fixation, and volar plate fixation. The nature of the fracture will determine the best treatment option, and surgeons employ a multifactorial treatment approach that includes the patient’s age, nature of injury, joint involvement, and displacement among other factors. Historically, closed reduction and percutaneous pinning have been the most popular approaches. However, volar plate fixation is quickly becoming a popular option as it minimizes tendon irritation, reduces immobilization time, and decreases risk of complication. The goal of treatment is to restore mobility, reduce pain, and improve functional outcomes following rehabilitation. The aim of this review is to summarize the most common treatments and importance of early referral to hand therapy to improve functional outcomes.

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Flexor Pollicis Longus Dysfunction After Volar Plate Fixation of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2013.06.005 ◽

2013 ◽

Vol 38 (9) ◽

pp. 1691-1697 ◽

Cited By ~ 9

Author(s):

Brian J. Chilelli ◽

Ronak M. Patel ◽

David M. Kalainov ◽

Jie Peng ◽

Li-Qun Zhang

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Volar Plate Fixation

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Intra articular distal radius fractures and volar plate fixation: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171907 ◽

2017 ◽

Vol 3 (3) ◽

pp. 589 ◽

Cited By ~ 1

Author(s):

Atin Kumar Kundu ◽

Nitin Wale ◽

Satyendra Phuljhele ◽

Deepak Ghritlahre ◽

Harjot Singh Gurudatta

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Fracture Pattern ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Range Of Movement ◽

Volar Approach ◽

Volar Plate Fixation

Background: Despite being one of the most common fractures encountered in patients, intra-articular distal radius fractures still pose therapeutic challenge to Orthopaedic surgeons. With the advent of locking plates, the fixation of these fractures has been made better, specifically by fixed angle volar locking plate. This study investigates the efficacy of these plates using volar approach, functional and clinical outcome, in addition to the radiological alignment.Methods: Thirty patients with closed distal radius fractures, with AO TYPE B3, B4, AND C fracture pattern, operated with distal radius plate fixation using volar approach, were included in the study during the period of August 2014 to August 2016. With a minimum follow up of six months, radiological outcome was analysed and functional outcome recorded (Gartland and Werley’s demerit scoring system).Results: With a mean age of 42 years and follow up of six months, the range of movement of the wrist was very satisfactory, and the mean grip strength was 80% of the opposite wrist. Radiological parameters were well‑maintained, and functional parameters by Gartland and Werley showed a significant improvement in most of the patients during the follow‑up period. The complication rate was less and insignificant.Conclusions: Primary volar plate fixation of intraarticular distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion.

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Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases

Journal of Orthopaedics ◽

10.1016/j.jor.2018.01.030 ◽

2018 ◽

Vol 15 (1) ◽

pp. 236-238 ◽

Cited By ~ 7

Author(s):

Kotaro Sato ◽

Kenya Murakami ◽

Yoshikuni Mimata ◽

Minoru Doita

Keyword(s):

Distal Radius ◽

Tendon Rupture ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Volar Plate Fixation

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Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1739961 ◽

2021 ◽

Author(s):

Arno A. Macken ◽

Jonathan Lans ◽

Sezai Özkan ◽

Simon Kramer ◽

Jesse B. Jupiter ◽

...

Keyword(s):

Distal Radius ◽

Rating Scale ◽

Outcome Measurement ◽

Plate Fixation ◽

Volar Plate ◽

Pain Patient ◽

Flexor Pollicis Longus ◽

Patient Reported ◽

Volar Plate Fixation

Abstract Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation. Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs. Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75). Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.

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