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



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.

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Correspondence to Oleg Dolkart.

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The authors declare that they have no conflicts of interest.

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

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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).

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