title: Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study.
abstract: OBJECTIVE
  To identify risk factors for tendon attrition after volar locking plate fixation of distal radius fractures.
  
  
  METHODS
  We prospectively assessed attrition of the flexor pollicis longus tendon at volar plate removal in 127 hands in 126 patients. We also evaluated preoperative lateral wrist radiographs, sonographs, and crepitus with flexor pollicis longus tendon motion and compared the demographic and radiographic characteristics of patients with and without tendon attrition. Multivariate logistic regression analysis was employed to identify the factors independently associated with tendon attrition.
  
  
  RESULTS
  We found 12 cases of tendon attrition (10%) and 1 that presented with tendon rupture in our cohort. Crepitus was recognized in 14 patients (11%): 6 cases (50%) were among the 12 hands in 12 patients with tendon attrition whereas 8 (7%) were detected in the remaining 114 hands in 113 patients. Logistic regression examination revealed that audible crepitus and volar placement of the plate in lateral radiographs were independent predictors of tendon attrition.
  
  
  CONCLUSIONS
  Crepitus and volar placement of hardware in lateral radiographs were independent risk factors for flexor tendon attrition after volar plating for distal radius fracture. These results may facilitate surgical decisions regarding early plate removal to prevent possible tendon rupture.
  
  
  METHODS
  Diagnostic II.
authors.affiliation: Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan. Electronic address: hiroshiymzk1017@ybb.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Komatsu
authors.affiliation: Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001314:Auscultation; D001860:Bone Plates; D015331:Cohort Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D053401:Palmar Plate / Q000601:surgery*; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014955:Wrist Joint; D055815:Young Adult
keywords: Distal radius fracture; crepitus; flexor tendon rupture; tendon attrition; volar locking plate