Skeletal Radiology

, Volume 47, Issue 6, pp 833–837 | Cite as

Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication

  • Hila Otremski
  • Oleg DolkartEmail author
  • Franck Atlan
  • Dan Hutt
  • Elad Segev
  • Tamir Pritsch
  • Yishai Rosenblatt
Scientific Article



Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication.


A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them.


Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system).


We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.


Hairline longitudinal fractures Distal radius fractures Volar plating Hardware-related complication 



There is no funding source.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The institutional review board approved this retrospective study (registration 0080–16-TLV).

Statement of human rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1975, as revised in 2008.


  1. 1.
    Lee DS, Weikert DR. Complications of distal radius fixation. Orthop Clin N Am. 2016;47(2):415–24.CrossRefGoogle Scholar
  2. 2.
    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(5):316–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Bentohami A, De Burlet K, De Korte N, van den Bekerom M, Goslings J, Schep N. Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg (Eur Vol). 2013;39(7):745–54.CrossRefGoogle Scholar
  4. 4.
    Hakimi M, Jungbluth P, Windolf J, Wild M. Functional results and complications following locking palmar plating on the distal radius: a retrospective study. J Hand Surg Eur Vol. 2010;35(4):283–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Johnson N, Cutler L, Dias J, Ullah A, Wildin C, Bhowal B. Complications after volar locking plate fixation of distal radius fractures. Injury. 2014;45(3):528–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Park JG, Cho NS, Song JH, Baek JH, Rhee YG. Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears: is tuberoplasty really applicable? J Shoulder Elbow Surg. 2016;25(2):224–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Sügün T, Gürbüz Y, Özaksar K, Toros T, Bal E, Kayalar M. A new complication in volar locking plating of the distal radius: longitudinal fractures of the near cortex. Acta Orthop Traumatol Turc. 2015;50(2):147–52.Google Scholar
  8. 8.
    Augat P, Schorlemmer S. The role of cortical bone and its microstructure in bone strength. Age Ageing. 2006;35(Suppl 2):ii27–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Kanis J, McCloskey E, Johansson H, Cooper C, Rizzoli R, Reginster J-Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57.CrossRefPubMedGoogle Scholar
  10. 10.
    Rubin KH, Friis-Holmberg T, Hermann AP, Abrahamsen B, Brixen K. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review. J Bone Miner Res. 2013;28(8):1701–17.CrossRefPubMedGoogle Scholar
  11. 11.
    Riggs BL, Lr M. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(5):S505–11.CrossRefGoogle Scholar
  12. 12.
    Acumed. Comparison of Acumed® Hex and Hexalobe Screws. 2014.Google Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Hila Otremski
    • 1
  • Oleg Dolkart
    • 1
    Email author
  • Franck Atlan
    • 1
  • Dan Hutt
    • 1
  • Elad Segev
    • 2
  • Tamir Pritsch
    • 1
  • Yishai Rosenblatt
    • 1
  1. 1.Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Faculty of ScienceHolon Institute of TechnologyHolonIsrael

Personalised recommendations