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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

29.10.2020 | Trauma Surgery

Volar locking plate removal after distal radius fracture: a 10-year retrospective study

verfasst von: Jun-Ku Lee, Younghun Lee, Choongki Kim, Minwook Kim, Soo-Hong Han

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 10/2021

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Abstract

Introduction

Distal radius fracture (DRF) is the most common upper extremity fracture. After the introduction of volar locking plate (VLP) fixation, treatment has shifted from conservative management to more operative management. The implant removal rate after VLP fixation in patients with DRF varies and the reasons for removal and associated patient characteristics have not been clearly defined. This study aimed to compare the characteristics of patients who underwent VLP with and without subsequent implant removal. Second, the rate of implant removal according to the implant position and type was investigated. Finally, we summarized clinical outcome with implant removal, the reasons for, and complications associated with implant removal.

Methods

In this retrospective study, patient data were collected between January 1, 2008, and December 31, 2017. The study population was divided into two groups based on subsequent implant removal. Data on patient characteristics, such as age, sex, comorbidities, side of the fractured arm, the AO Foundation and Orthopaedic Trauma Association classification of the DRF, plate position grade based on the Soong classification type, type of inserted plate, insurance coverage, and treatment costs were collected. Furthermore, we investigated the reason for implant removal, clinical outcomes, and post-removal complications.

Results

After applying the exclusion criteria, 806 patients with a total of 814 DRFs were included in the study. Among the 806 patients who underwent VLP fixation for DRF, 252 (31.3%) patients underwent implant removal. Among the patients undergoing implant removal, the mean age was 50.8 ± 14.0 years, 94 (37.3%) were male. The average time to implant removal from the fracture fixation was 12.1 ± 9.2 months (range 1–170 months). When comparing groups, patients who underwent implant removal were significantly younger and had fewer cases of diabetes, hypertension, and cancer history. According to the Soong plate position grade, the most common position was G1 in both groups. Although there was no significant difference (p = 0.075), more G2 cases were found in the removal group (15.0%) than in the retention group (10.2%). About 66.5% of the patients with implant removal had other health insurance as well as the national service, compared with 47% of the patients with implant retention. In total, 186 patients (73.8%) underwent implant removal despite being asymptomatic after the bony union. The patient satisfaction scores improved from 4.1 to 4.4 after implant removal, and 93% of the patients answered that they would choose implant removal again. Only 10% of the patients who underwent removal reported minor complications. No major complications were reported.

Conclusion

Although the implant removal was conducted without clinical symptoms in the majority of patients, overall patients presented improved functional outcomes with implant removal. The evidence is inconclusive regarding its necessity, however, implant removal after VLP fixation for DRF is not a challenging procedure and is not associated with major complications.

Level of evidence

Level IV.

Ruch DS, McQeen MM (2015) Distal radius and ulna fractures. In: Bucholz RW, Beaty JH, Rockwood CA, Jr; Green DP (eds) Rockwood and Green's fractures in adults, vol 1, 7th edn. Wolter Kluwer Health/Lippincott, Wiliams & Wilkins, Philadelphia.

Singh RP, Carter LM, Whitfield PH (2013) Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome. Br J Oral Maxillofacial Surg 51(5):444–447. https://doi.org/10.1016/j.bjoms.2012.08.019CrossRef

Wilcke MK, Hammarberg H, Adolphson PY (2013) Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop 84(3):292–296. https://doi.org/10.3109/17453674.2013.792035CrossRefPubMedPubMedCentral

Hevonkorpi TP, Launonen AP, Huttunen TT, Kannus P, Niemi S, Mattila VM (2018) Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on? BMC Musculoskelet Disord 19(1):70. https://doi.org/10.1186/s12891-018-1983-0CrossRefPubMedPubMedCentral

Lee DY, Park YJ, Park JS (2019) A meta-analysis of studies of volar locking plate fixation of distal radius fractures: conventional versus minimally invasive plate osteosynthesis. Clin Orthopedic Surg 11(2):208–219. https://doi.org/10.4055/cios.2019.11.2.208CrossRef

Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P (2012) Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury 43(2):174–179. https://doi.org/10.1016/j.injury.2011.05.021CrossRefPubMed

McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C (2011) Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury 42(2):162–166. https://doi.org/10.1016/j.injury.2010.07.236CrossRefPubMed

Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A (2011) Removal of locked volar plates after distal radius fractures. J Hand Surg Am 36(6):982–985. https://doi.org/10.1016/j.jhsa.2011.03.032CrossRefPubMed

Musgrave DS, Idler RS (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 30(4):743–749. https://doi.org/10.1016/j.jhsa.2005.03.006CrossRefPubMed

10.

Alter TH, Sandrowski K, Gallant G, Kwok M, Ilyas AM (2019) Complications of volar plating of distal radius fractures: a systematic review. J Wrist Surg 8(3):255–262. https://doi.org/10.1055/s-0038-1667304CrossRefPubMed

11.

Dennison DG (2010) Distal radius fractures and titanium volar plates: should we take the plates out? J Hand Surg Am 35(1):141–143. https://doi.org/10.1016/j.jhsa.2009.10.029CrossRefPubMed

12.

Busam ML, Esther RJ, Obremskey WT (2006) Hardware removal: indications and expectations. J Am Acad Orthop Surg 14(2):113–120. https://doi.org/10.5435/00124635-200602000-00006CrossRefPubMed

13.

Yamamoto M, Fujihara Y, Fujihara N, Hirata H (2017) A systematic review of volar locking plate removal after distal radius fracture. Injury 48(12):2650–2656. https://doi.org/10.1016/j.injury.2017.10.010CrossRefPubMed

14.

Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21(5):316–322. https://doi.org/10.1097/BOT.0b013e318059b993CrossRefPubMed

15.

Rozental TD, Blazar PE (2006) Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 31(3):359–365. https://doi.org/10.1016/j.jhsa.2005.10.010CrossRefPubMed

16.

Tarallo L, Adani R, Mugnai R, Catani F (2011) The treatment of distal radius articular fractures of C1–C2 type with DVR plate: analysis of 40 cases. Musculoskelet Surg 95(3):225–230. https://doi.org/10.1007/s12306-011-0140-9CrossRefPubMed

17.

Jakubietz MG, Gruenert JG, Jakubietz RG (2012) Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term? J Orthop Surg Res 7(1):8. https://doi.org/10.1186/1749-799X-7-8CrossRefPubMedPubMedCentral

18.

Tan A, Chong A (2016) Reasons for implant removal after distal radius fractures. J Hand Surg Asian-Pacific 21(3):321–325. https://doi.org/10.1142/s2424835516500284CrossRef

19.

Vos DI, Verhofstad MH (2013) Indications for implant removal after fracture healing: a review of the literature. Eur J Trauma Emerg Surg 39(4):327–337. https://doi.org/10.1007/s00068-013-0283-5CrossRefPubMed

20.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 370(9596):1453–1457. https://doi.org/10.1016/s0140-6736(07)61602-xCrossRef

21.

Tang JB (2009) Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur 34(1):137–138. https://doi.org/10.1177/17531934097321CrossRef

22.

Soong M, Earp BE, Bishop G, Leung A, Blazar P (2011) Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 93(4):328–335. https://doi.org/10.2106/jbjs.J.00193CrossRefPubMed

23.

Rubensson CC, Ydreborg K, Boren L, Karlander LE (2015) Flexor tendon repair after rupture caused by volar plate fixation of the distal radius. J Plast Surg Hand Surg 49(2):112–115. https://doi.org/10.3109/2000656X.2014.951050CrossRefPubMed

24.

Selles CA, Reerds STH, Roukema G, van der Vlies KH, Cleffken BI, Schep NWL (2018) Relationship between plate removal and Soong grading following surgery for fractured distal radius. J Hand Surg Eur 43(2):137–141. https://doi.org/10.1177/1753193417726636CrossRef

25.

Cross AW, Schmidt CC (2008) Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am 33(2):164–167. https://doi.org/10.1016/j.jhsa.2007.11.011CrossRefPubMed

26.

Kitay A, Swanstrom M, Schreiber JJ, Carlson MG, Nguyen JT, Weiland AJ, Daluiski A (2013) Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am 38(6):1091–1096. https://doi.org/10.1016/j.jhsa.2013.03.011CrossRefPubMed

27.

Asadollahi S, Keith PP (2013) Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthop Traumatol 14(4):227–234. https://doi.org/10.1007/s10195-013-0245-zCrossRefPubMedPubMedCentral

28.

Jung HS, Jung HS, Baek SH, Lee JS (2020) How many screws are needed for reliable stability of extra-articular nonosteoporotic distal radius fractures fixed with volar locking plates? Clin Orthop Surg 12(1):22–28. https://doi.org/10.4055/cios.2020.12.1.22CrossRefPubMedPubMedCentral

29.

Hanson B, van der Werken C, Stengel D (2008) Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord 9:73. https://doi.org/10.1186/1471-2474-9-73CrossRefPubMedPubMedCentral

30.

Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND (2015) Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am 40(3):505–507. https://doi.org/10.1016/j.jhsa.2014.11.022CrossRefPubMed

31.

Marlow WJ, Singhal R, Dheerendra S, Ralte P, Fischer J, Waseem M (2012) Distal radius volar locking plates: does a variable angle locking system confer a clinical advantage? Acta Orthop Belg 78(3):309–316PubMed

32.

Ehlinger M, Adam P, Simon P, Bonnomet F (2009) Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res 95(5):373–376. https://doi.org/10.1016/j.otsr.2009.03.020CrossRefPubMed

33.

Bae JH, Oh JK, Oh CW, Hur CR (2009) Technical difficulties of removal of locking screw after locking compression plating. Arch Orthop Trauma Surg 129(1):91–95. https://doi.org/10.1007/s00402-008-0769-5CrossRefPubMed

Titel: Volar locking plate removal after distal radius fracture: a 10-year retrospective study
verfasst von: Jun-Ku Lee
Younghun Lee
Choongki Kim
Minwook Kim
Soo-Hong Han
Publikationsdatum: 29.10.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 10/2021
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03637-7

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