Complications of Volar Plating of Distal Radius Fractures: A Systematic Review

Abstract

Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear.

Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF.

Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up.

Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%).

Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.

Keywords

distal radius fracture - volar locking plate - complications

• References

• 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37 (08) 691-697
• 2 Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015; 29 (08) e242-e244
• 3 Kilgore ML, Morrisey MA, Becker DJ. , et al. Health care expenditures associated with skeletal fractures among Medicare beneficiaries, 1999-2005. J Bone Miner Res 2009; 24 (12) 2050-2055
• 4 Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable Colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 2009; 23 (04) 237-242
• 5 Bales JG, Stern PJ. Treatment strategies of distal radius fractures. Hand Clin 2012; 28 (02) 177-184
• 6 Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am 2015; 40 (01) 34-41
• 7 Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: current concepts. J Hand Surg Am 2012; 37 (08) 1718-1725
• 8 Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 2009; 91 (08) 1868-1873
• 9 Hakimi M, Jungbluth P, Windolf J, Wild M. Functional results and complications following locking palmar plating on the distal radius: a retrospective study. J Hand Surg Eur Vol 2010; 35 (04) 283-288
• 10 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
• 11 Cui Z, Pan J, Yu B, Zhang K, Xiong X. Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis. Int Orthop 2011; 35 (09) 1333-1341
• 12 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861
• 13 Rampoldi M, Marsico S. Complications of volar plating of distal radius fractures. Acta Orthop Belg 2007; 73 (06) 714-719
• 14 Zenke Y, Sakai A, Oshige T. , et al. Extensor pollicis longus tendon ruptures after the use of volar locking plates for distal radius fractures. Hand Surg 2013; 18 (02) 169-173
• 15 Asadollahi S, Keith PP. Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthop Traumatol 2013; 14 (04) 227-234
• 16 Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. Comparison of risk of Carpal Tunnel syndrome in patients with distal radius fractures after 7 treatments. Med Sci Monit 2015; 21: 2837-2844
• 17 Fowler JR, Ilyas AM. Prospective evaluation of distal radius fractures treated with variable-angle volar locking plates. J Hand Surg Am 2013; 38 (11) 2198-2203
• 18 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (05) 316-322
• 19 Brennan SA, Kiernan C, Beecher S. , et al. Volar plate versus k-wire fixation of distal radius fractures. Injury 2016; 47 (02) 372-376
• 20 Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am 2008; 33 (06) 809-819
• 21 Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 2006; 88 (12) 2687-2694
• 22 Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 2010; 68 (04) 992-998
• 23 Figl M, Weninger P, Liska M, Hofbauer M, Leixnering M. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 2009; 129 (05) 661-669
• 24 Gruber G, Gruber K, Giessauf C. , et al. Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients. J Orthop Trauma 2008; 22 (07) 467-472
• 25 Gereli A, Nalbantoglu U, Kocaoglu B, Turkmen M. Comparative study of the closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO type A2 distal radius fractures. Arch Orthop Trauma Surg 2014; 134 (01) 121-129
• 26 Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M. Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc 2010; 44 (03) 212-219
• 27 Goehre F, Otto W, Schwan S, Mendel T, Vergroesen PP, Lindemann-Sperfeld L. Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients. J Hand Surg Eur Vol 2014; 39 (03) 249-257
• 28 Gogna P, Selhi HS, Singla R. , et al. Osteosynthesis with long volar locking plates for metaphyseal-diaphyseal fractures of the distal radius. Chin J Traumatol 2013; 16 (06) 339-343
• 29 Gradl G, Mielsch N, Wendt M. , et al. Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial. Injury 2014; 45 (Suppl. 01) S3-S8
• 30 Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB. Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 2013; 133 (05) 595-602
• 31 Grewal R, MacDermid JC, King GJW, Faber KJ. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am 2011; 36 (12) 1899-1906
• 32 Gruber G, Zacherl M, Giessauf C. , et al. Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Joint Surg Am 2010; 92 (05) 1170-1178
• 33 Hollevoet N, Vanhoutie T, Vanhove W, Verdonk R. Percutaneous K-wire fixation versus palmar plating with locking screws for Colles' fractures. Acta Orthop Belg 2011; 77 (02) 180-187
• 34 Karantana A, Downing ND, Forward DP. , et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (19) 1737-1744
• 35 Kato S, Tatebe M, Yamamoto M, Iwatsuki K, Nishizuka T, Hirata H. The results of volar locking plate fixation for the fragility fracture population with distal radius fracture in Japanese women. Nagoya J Med Sci 2014; 76 (1-2): 101-111
• 36 Kawasaki K, Nemoto T, Inagaki K, Tomita K, Ueno Y. Variable-angle locking plate with or without double-tiered subchondral support procedure in the treatment of intra-articular distal radius fracture. J Orthop Traumatol 2014; 15 (04) 271-274
• 37 Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A. Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury 2011; 42 (04) 393-396
• 38 Knight D, Hajducka C, Will E, McQueen M. Locked volar plating for unstable distal radial fractures: clinical and radiological outcomes. Injury 2010; 41 (02) 184-189
• 39 Konstantinidis L, Helwig P, Strohm PC, Hirschmüller A, Kron P, Südkamp NP. Clinical and radiological outcomes after stabilisation of complex intra-articular fractures of the distal radius with the volar 2.4 mm LCP. Arch Orthop Trauma Surg 2010; 130 (06) 751-757
• 40 Kumbaraci M, Kucuk L, Karapinar L, Kurt C, Coskunol E. Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures. Eur J Orthop Surg Traumatol 2014; 24 (02) 173-178
• 41 Kwan K, Lau TW, Leung F. Operative treatment of distal radial fractures with locking plate system-a prospective study. Int Orthop 2011; 35 (03) 389-394
• 42 Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A. Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg Am 2008; 33 (07) 1135-1143
• 43 Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. J Trauma 2011; 70 (06) 1510-1518
• 44 Lee YS, Wei TY, Cheng YC, Hsu TL, Huang CR. A comparative study of Colles' fractures in patients between fifty and seventy years of age: percutaneous K-wiring versus volar locking plating. Int Orthop 2012; 36 (04) 789-794
• 45 Marlow WJ, Singhal R, Dheerendra S, Ralte P, Fischer J, Waseem M. Distal radius volar locking plates: does a variable angle locking system confer a clinical advantage?. Acta Orthop Belg 2012; 78 (03) 309-316
• 46 Matschke S, Marent-Huber M, Audigé L, Wentzensen A. ; LCP Study Group. The surgical treatment of unstable distal radius fractures by angle stable implants: a multicenter prospective study. J Orthop Trauma 2011; 25 (05) 312-317
• 47 Matschke S, Wentzensen A, Ring D, Marent-Huber M, Audigé L, Jupiter JB. Comparison of angle stable plate fixation approaches for distal radius fractures. Injury 2011; 42 (04) 385-392
• 48 Mellstrand Navarro C, Ahrengart L, Törnqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. J Orthop Trauma 2016; 30 (04) 217-224
• 49 Minegishi H, Dohi O, An S, Sato H. Treatment of unstable distal radius fractures with the volar locking plate. Ups J Med Sci 2011; 116 (04) 280-284
• 50 Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 2008; 33 (05) 691-700
• 51 Phadnis J, Trompeter A, Gallagher K, Bradshaw L, Elliott DS, Newman KJ. Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg 2012; 7: 4
• 52 Plate JF, Gaffney DL, Emory CL. , et al. Randomized comparison of volar locking plates and intramedullary nails for unstable distal radius fractures. J Hand Surg Am 2015; 40 (06) 1095-1101
• 53 Rampoldi M, Palombi D, Tagliente D. Distal radius fractures with diaphyseal involvement: fixation with fixed angle volar plate. J Orthop Traumatol 2011; 12 (03) 137-143
• 54 Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (08) 1837-1846
• 55 Sonderegger J, Schindele S, Rau M, Gruenert JG. Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?. Arch Orthop Trauma Surg 2010; 130 (10) 1263-1268
• 56 Souer JS, Ring D, Matschke S, Audige L, Maren-Hubert M, Jupiter J. Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius. J Hand Surg Am 2010; 35 (03) 398-405
• 57 Sügün TS, Gürbüz Y, Özaksar K, Toros T, Kayalar M, Bal E. Results of volar locking plating for unstable distal radius fractures. Acta Orthop Traumatol Turc 2012; 46 (01) 22-25
• 58 Takada N, Otsuka T, Yamada K. , et al. Minimally invasive plate osteosynthesis for distal radius fractures with a palmar locking plate. Eur J Trauma Emerg Surg 2012; 38 (06) 627-632
• 59 Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma 2013; 27 (12) 740-745
• 60 Vlček M, Jaganjac E, Pech J, Jonáš D, Kebrle R. Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?. Bosn J Basic Med Sci 2014; 14 (02) 81-88
• 61 Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (07) 1568-1577
• 62 Wei XM, Sun ZZ, Rui YJ, Song XJ. Minimally invasive plate osteosynthesis for distal radius fractures. Indian J Orthop 2014; 48 (01) 20-24
• 63 Wichlas F, Haas NP, Disch A, Machó D, Tsitsilonis S. Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures. J Orthop Traumatol 2014; 15 (04) 259-264
• 64 Wilcke MKT, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop 2011; 82 (01) 76-81
• 65 Williksen JH, Frihagen F, Hellund JC, Kvernmo HD, Husby T. Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study. J Hand Surg Am 2013; 38 (08) 1469-1476
• 66 Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36 (07) 1135-1141
• 67 Zenke Y, Sakai A, Oshige T. , et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma 2011; 25 (07) 425-431
• 68 Protopsaltis TS, Ruch DS. Volar approach to distal radius fractures. J Hand Surg Am 2008; 33 (06) 958-965
• 69 Azzi AJ, Aldekhayel S, Boehm KS, Zadeh T. Tendon rupture and tenosynovitis following internal fixation of distal radius fractures: a systematic review. Plast Reconstr Surg 2017; 139 (03) 717e-724e