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

Abstract

Objectives

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

Methods

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.

Results

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).

Conclusions

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.

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References

  1. Lee DS, Weikert DR. Complications of distal radius fixation. Orthop Clin N Am. 2016;47(2):415–24.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Augat P, Schorlemmer S. The role of cortical bone and its microstructure in bone strength. Age Ageing. 2006;35(Suppl 2):ii27–31.

    Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  11. Riggs BL, Lr M. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(5):S505–11.

    Article  Google Scholar 

  12. Acumed. Comparison of Acumed® Hex and Hexalobe Screws. 2014.

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Correspondence to Oleg Dolkart.

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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.

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Otremski, H., Dolkart, O., Atlan, F. et al. Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication. Skeletal Radiol 47, 833–837 (2018). https://doi.org/10.1007/s00256-018-2877-9

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  • DOI: https://doi.org/10.1007/s00256-018-2877-9

Keywords

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