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J Hand Microsurg 2023; 15(03): 212-218
DOI: 10.1055/s-0041-1739961
Original Article

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Arno A. Macken
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Jonathan Lans
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Sezai Özkan
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Simon Kramer
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Jesse B. Jupiter
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Neal C. Chen
1   Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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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.

Keywords

distal radius fracture - flexor pollicis longus - tendon - attrition - rupture - patient-reported outcome - soong grade


Publikationsverlauf

Artikel online veröffentlicht:
23. November 2021

© 2021. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 2006; 445 (445) 58-67
    CrossrefPubMedSuche in Google Scholar
  • 2 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
    CrossrefPubMedSuche in Google Scholar
  • 3 Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol 2009; 34 (04) 471-474
    CrossrefPubMedSuche in Google Scholar
  • 4 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
    PubMedSuche in Google Scholar
  • 5 Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury 2017; 48 (06) 1104-1109
    CrossrefPubMedSuche in Google Scholar
  • 6 White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am 2012; 37 (10) 2035-2040
    CrossrefPubMedSuche in Google Scholar
  • 7 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
    CrossrefPubMedSuche in Google Scholar
  • 8 Sato K, Murakami K, Mimata Y, Doita M. Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases. J Orthop 2018; 15 (01) 236-238
    CrossrefPubMedSuche in Google Scholar
  • 9 DeGeorge Jr BR, Brogan DM, Shin AY. The relationship of volar plate position and flexor tendon rupture: should we question the validity of the Soong classification?. Plast Reconstr Surg 2020; 146 (03) 581-588
    CrossrefPubMedSuche in Google Scholar
  • 10 DeGeorge Jr BR, Brogan DM, Becker HA, Shin AY. Incidence of complications following volar locking plate fixation of distal radius fractures: an analysis of 647 cases. Plast Reconstr Surg 2020; 145 (04) 969-976
    CrossrefPubMedSuche in Google Scholar
  • 11 Cook A, Baldwin P, Fowler JR. Incidence of flexor pollicis longus complications following volar locking plate fixation of distal radius fractures. Hand (N Y) 2020; 15 (05) 692-697
    CrossrefPubMedSuche in Google Scholar
  • 12 Yamak K, Karahan HG, Karatan B, Kayalı C, Altay T. Evaluation of flexor pollicis longus tendon rupture after treatment of distal radius fracture with the volar plate. J Wrist Surg 2020; 9 (03) 219-224
    Thieme ConnectPubMedSuche in Google Scholar
  • 13 Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003; 27 (01) 1-6
    CrossrefPubMedSuche in Google Scholar
  • 14 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
    CrossrefPubMedSuche in Google Scholar
  • 15 Cross AW, Schmidt CC. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am 2008; 33 (02) 164-167
    CrossrefPubMedSuche in Google Scholar
  • 16 Adham MN, Porembski M, Adham C. Flexor tendon problems after volar plate fixation of distal radius fractures. Hand (N Y) 2009; 4 (04) 406-409
    CrossrefPubMedSuche in Google Scholar
  • 17 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (04) 328-335
    CrossrefPubMedSuche in Google Scholar
  • 18 Kitay A, Swanstrom M, Schreiber JJ. et al. Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am 2013; 38 (06) 1091-1096
    CrossrefPubMedSuche in Google Scholar
  • 19 Wilson J, Viner JJ, Johal KS, Woodruff MJ. volar locking plate fixations for displaced distal radius fractures: an evaluation of complications and radiographic outcomes. Hand (N Y) 2018; 13 (04) 466-472
    CrossrefPubMedSuche in Google Scholar
  • 20 Gören Y, Sauerbier M, Arsalan-Werner A. Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures. J Hand Surg Eur Vol 2020; 45 (04) 348-353
    CrossrefPubMedSuche in Google Scholar
  • 21 Tanaka Y, Aoki M, Izumi T, Fujimiya M, Yamashita T, Imai T. Effect of distal radius volar plate position on contact pressure between the flexor pollicis longus tendon and the distal plate edge. J Hand Surg Am 2011; 36 (11) 1790-1797
    CrossrefPubMedSuche in Google Scholar
  • 22 Figl M, Mayer M, Lederer S, Bogner R, Leixnering M. Extensor pollicis longus rupture after distal radius fracture: results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting. Wien Klin Wochenschr 2011; 123 (15-16) 485-487
    CrossrefPubMedSuche in Google Scholar
  • 23 Berger P, Duerinckx J. Flexor pollicis longus tendon rupture after volar wrist plating: reconstruction with palmaris longus interposition graft. Acta Orthop Belg 2017; 83 (03) 467-472
    PubMedSuche in Google Scholar
  • 24 Zukawa M, Osada R, Makino H, Kimura T. Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon. Plast Reconstr Surg 2019; 143 (01) 176-180
    CrossrefPubMedSuche in Google Scholar
  • 25 Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986; 27 (01) 117-126
    Suche in Google Scholar
  • 26 Tyser AR, Beckmann J, Franklin JD. et al. Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 2014; 39 (10) 2047-2051.e4
    CrossrefPubMedSuche in Google Scholar
  • 27 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
    PubMedSuche in Google Scholar
  • 28 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    Suche in Google Scholar
  • 29 Soong M, van R Leerdam, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 2011; 36 (01) 3-9
    CrossrefPubMedSuche in Google Scholar
  • 30 Rogers J, Hayes M, Van Demark REJ. Delayed rupture of the flexor pollicis longus after volar plating for a distal radius fracture: a case report. S D Med 2019; 72 (11) 514-517
    PubMedSuche in Google Scholar
  • 31 Tada K, Ikeda K, Shigemoto K, Suganuma S, Tsuchiya H. Prevention of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures. Hand Surg 2011; 16 (03) 271-275
    CrossrefPubMedSuche in Google Scholar
  • 32 Selvan DR, Perry D, Machin DG, Brown DJ. The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures - a case control study. Injury 2014; 45 (12) 1885-1888
    CrossrefPubMedSuche in Google Scholar
  • 33 Unglaub F, Bultmann C, Reiter A, Hahn P. Two-staged reconstruction of the flexor pollicis longus tendon. J Hand Surg [Br] 2006; 31 (04) 432-435
    CrossrefPubMedSuche in Google Scholar
  • 34 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
    CrossrefPubMedSuche in Google Scholar
  • 35 Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg Br 2008; 90 (09) 1214-1221
    CrossrefPubMedSuche in Google Scholar
  • 36 Brennan SA, Kiernan C, Beecher S. et al. Volar plate versus k-wire fixation of distal radius fractures. Injury 2016; 47 (02) 372-376
    CrossrefPubMedSuche in Google Scholar
  • 37 Schmitt S, Mühldorfer-Fodor M, van Schoonhoven J, Prommersberger KJ. [Restoration of thumb flexion at the interphalangeal joint by transposition of the flexor digitorum superficialis tendon from the ring finger]. Oper Orthop Traumatol 2013; 25 (04) 321-330
    PubMedSuche in Google Scholar