Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up.
BACKGROUND
Volar plating of unstable distal radius fractures (DRF) has become the favoured treatment. The complication rates vary from 3 to 36%. The purpose of the study was to estimate the complication rate of volar plating of DRF and its association with AO/OTA fracture type, surgeon experience and type of volar plate.


METHODS
Retrospectively, all patients treated with volar plating of a DRF between February 2009 and June 2013 at Aarhus University Hospital, Denmark were included. AO/OTA fracture type, surgeon experience (1st year, 2nd-5th year resident or consultant), type of plate (VariAx®, Acu-Loc®) and complications were extracted from the electronic medical records. Complications were categorized as carpal tunnel syndrome, other sensibility issues, tendon complications including irritation and rupture, deep infections, complex regional pain syndrome and unidentified DRUJ or scapholunar problems. Reoperations including hardware removal were also charted.


RESULTS
576 patients with a median age of 63 years (min: 15; max: 87) were included. 78% were female and the mean observation time was 3.2 years (min: 2.0; max: 5.4). 78% (n=451) of the patients were treated with VariAx®and 22% (n=125) with Acu-Loc®. The overall complication rate was 14.6% (95% CI 11.8-17.7) including carpal tunnel syndrome or change in sensibility in 5.2% and tendon complications in 4.7%. Five flexor tendon ruptures and 12 extensor tendon ruptures were observed. The reoperation rate was 10.4% including 41 cases of hardware removal. A statistically significant association between AO/OTA fracture type C and complications was found. No statistically significant association between complication rate and surgeon experience and type of plate was observed.


CONCLUSIONS
The majority of DRF patients treated with a volar plate suffer no complications. However, the overall complication rate of 14.6% is substantial. Intra-articular fractures, e.g. AO/OTA-type 23C1-3, had significantly higher complication rates. Neither surgeon experience, nor type of volar plate was able to predict complications.
Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark. Electronic address: rikkthor@rm.dk.
Rikke
R
Thorninger
Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark.
Mette Lund
ML
Madsen
Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark; Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
Daniel
D
Wæver
Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
Lars Carl
LC
Borris
Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
Jan Hendrik Duedal
JHD
Rölfing
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects; D002349:Carpal Tunnel Syndrome / Q000209:etiology / Q000601:surgery; D020918:Complex Regional Pain Syndromes / Q000209:etiology / Q000601:surgery; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011885:Radius Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
Complication; Distal radius fracture; ORIF; Volar plate; Volar plating; Wrist trauma