Complications of volar plating of distal radius fractures

Open reduction and internal fixation has been shown to be effective in the treatment of unstable distal radius fractures. When a dorsal approach is used, extensor tendons rupture or irritation are frequent and well known complications. Complications associated with volar plate fixation have not been studied to the same extent. In this study a homogenous series of 90 patients treated by volar plate fixation were retrospectively evaluated, focusing on the complications observed. The overall rate of complications was 8% (7 cases). Tendon rupture or irritation of extensor (3 cases) and flexor tendons (2 cases) were the complications most frequently seen. All but one were clearly related to direct attritional damage of the tendon caused by the prominent edge of the plate or by protruding screw tips. Loss of reduction requiring repeat internal fixation was observed in one marginal shear fracture involving the Innate facet fragment. One patient had a carpal tunnel release owing to median nerve irritation. In this study, volar plate fixation appeared as a safe procedure in the management of unstable distal radius fractures, with a low rate of complications. Accurate placement of the plate and exact measurement of the screws may further minimize the incidence of complications. When radiographs reveal conditions that may predispose to tendon attritional lesions (prominent edge of the plate, dorsal protrusion of the screw tips) we strongly recommend early removal of the fixation device.