Sagittal and Coronal Plate Position Is Not Associated With Flexor Tendon Irritation, Rupture, or Need for Plate Removal After Volar Locking Plate Fixation of Distal Radius Fractures.

Background: Whether sagittal and coronal plate placement influences the risk of flexor tendon complications after volar plating of distal radius fractures is debated. In this study, we tested the null hypothesis that sagittal and coronal plate position is not associated with flexor tendon irritation, rupture, or plate removal.

Methods: We performed a retrospective review of 144 patients treated for distal radius fractures with a volar locking plate by 4 fellowship-trained hand surgeons. Patient, surgical, and radiographic factors were recorded, including measures of sagittal (Soong grade) and coronal (plate translation index) plate position and volar tilt. Outcomes assessed were flexor tendon irritation, rupture, and plate removal for any reason. We used multivariable logistic regression models to adjust for patient and surgical factors.

Results: Of 144 patients treated with volar locking plates (mean follow-up: 18 months), 22 (15%) patients developed flexor tendon irritation, 2 patients (1%) developed flexor tendon rupture, and 18 (13%) patients underwent subsequent plate removal. In the univariable analysis, neither Soong grade nor plate translation index was associated with flexor tendon irritation, flexor tendon rupture, or plate removal. Even after adjusting for the effects of age, sex, laterality, and volar tilt, neither Soong grade nor plate translation index was associated with flexor tendon irritation or plate removal.

Conclusions: Soong grade and plate translation index were not associated with the incidence of flexor tendon irritation, rupture, or need for plate removal. Plate placement in the coronal and sagittal planes can be determined based on the needs of the fracture pattern.