Removal of volar plate after open reduction internal fixation of distal radius fractures : clinical and radiographic analysis

The operative treatment of distal radius fractures had evolved over the years. In the last two decades anatomic locking plates were introduced and are increasingly being used for this indication becoming the most common surgical fixation for distal radius fractures. This study investigated how often plate removal is related to preventable reasons such as plate and screw positioning, screw length, and quality of reduction. All patients who underwent volar plate removal in our institution between the years 2006-2014 were included in this study. Patients' charts were retrospectively reviewed, and preoperative radiographs were analyzed including plate to volar rim distance (PVR), plate to critical line distance (PCR), Soong classification, implant position, and screw prominence. A total of 50 patients (26 males, 24 females) were identified. Patients with subjective feeling of prominent implant were found to be younger than the rest of the cohort. In addition, this complaint was associated with ulnar prominence of the proximal part of the plate due to malposition on the coronal plane. Extensor tendon irritation was associated with prominence of the proximal screws. Only one case was associated with flexor tendon irritation and there was no association to the Soong grade or PCL and PVR measurements. We believe that good fracture reduction, correct plate positioning, and appropriate screw location and length, can largely limit the need for volar plate removal.