Does Removal Of Volar Locking Plate Affect Patient Functional Outcomes?

Year 2024, , 90 - 95, 27.09.2024

Enver Kılıç , Mehmet Fatih Savaş

https://doi.org/10.5505/achmedj.2024.73745

Abstract

Introductıon: The aim of our study is to evaluate the effect of volar locking plate (VLP) removal on functional scores.
Methods: In this retrospective study, between January 2019 and January 2024, medical records of our institution were reviewed and patients who underwent VLP removal were included in the study. Demographic characteristics of the patients, follow-up time until VLP removal and reasons of VLP removal were evaluated from medical records. Preoperative and postoperative 3rd month Disabilities of Arm, Shoulder and Hand (DASH) scores were evaluated. Soong classification was performed on lateral wrist radiographs.
Results: Thirty-eight patients (24 male, 14 female) patients were included in the study. The mean age of all patients was 51.23±15.6 years. The mean time from VLP fixation to implant removal was 17.42±12.42 months. Patients who underwent implant removal were evaluated according to the Soong classification. 18 of the patients (%47.36) were grade 0, 16 of the patients (%42.1) were grade 1 and 4 of the patients (%10.54) were grade 2. The most common removal reason was patient request (n=26, %68.42). Preoperative mean DASH score was 19.1 and postoperative 3rd month mean DASH score was 8.2. There was a significant difference between preoperative and postoperative 3rd month DASH scores. (p<0.001) When patients were asked whether they would choose to implant removed again if they were in the same situation, %94.7 of the patients stated that they would choose implant removal again.compared to those with only one previous cesarean section (p=0.015).
Conclusion: VLP removal provided significant improvement in the patients’ functional outcomes. The most common reason for VLP removal was patient request.

Keywords

Volar locking plate, Implant removal, Functional outcome.

References

• 1. Court-Brown CM, Caesar B. Epidemiology of adult fractures:va review. Injury 2006;37(8):691–697.
• 2. Hagino H, Yamamoto K, Ohshiro H, Nose T. Increasing incidence of distal radius fractures in Japanese children and adolescents. J Orthop Sci 2000;5(4):356–360.
• 3. Flinkkila T, Sirnio K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P, Hyvonen P, Leppilahti J. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int 2011;22(8):2307–2312.
• 4. Hevonkorpi TP, Launonen AP, Huttunen TT, Kannus P, Niemi S, Mattila VM. Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 – too many patients are yet operated on? BMC Musculoskelet Disord 2018;19(1):70.
• 5. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, Keller RB. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 1996;7(6):612–618.
• 6. Levin LS, Rozell JC, Pulos N. Distal Radius fractures in the elderly. J Am Acad Orthop Surg 2017;25(3):179–187.
• 7. Huetteman HE, Shauver MJ, Malay S, Chung TT, Chung KC. Variation in the treatment of distal radius fractures in the United States: 2010 to 2015. Plast Reconstr Surg 2019;143(1):159–167.
• 8. Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Jt J 2014;96-B(7):963–969.
• 9. Ruch DS, McQeen MM (2015) Distal radius and ulna fractures. In: Bucholz RW, Beaty JH, Rockwood CA, Jr; Green DP (eds) Rockwood and Green’s fractures in adults, 2015;vol 1, 7th edn. Wolter Kluwer Health/Lippincott, Wiliams & Wilkins, Philadelphia.
• 10. Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury 2012;43(2):174–179.
• 11. McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury 2011;42(2):162–166.
• 12. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. J Hand Surg Am 2011;36(6):982–985.
• 13. Alter TH, Sandrowski K, Gallant G, Kwok M, Ilyas AM. Complications of volar plating of distal radius fractures: a systematic review. J Wrist Surg 2019;8(3):255–262.
• 14. Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 2005;30(4):743–749.
• 15. Dennison DG. Distal radius fractures and titanium volar plates: should we take the plates out? J Hand Surg Am 2010;35(1):141–143.
• 16. Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg 2006;14(2):113–120.
• 17. Yamamoto M, Fujihara Y, Fujihara N, Hirata H. A systematic review of volar locking plate removal after distal radius fracture. Injury 2017;48(12):2650–2656.
• 18. 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):316–322.
• 19. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 2009;17(6):369–377
• 20. Gyuricza C, Carlson MG, Weiland AJ, Wolfe SW, Hotchkiss RN, Daluiski A. Removal of locked volar plates after distal radius fractures. J Hand Surg Am 2011;36(6):982–985.
• 21. Satake H, Hanaka N, Honma R, Watanabe T, Inoue S. Complications of distal radius fractures treated by volar locking plate fixation. Orthopedics 2016;39(5):e893–e896.
• 22. Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND. Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am 2015;40(3):505–507.
• 23. Tan A, Chong A. Reasons for implant removal after distal radius fractures. J Hand Surg Asian-Pacific 2016;21(3):321–325.
• 24. Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93(4):328e335.
• 25. Palola V, Ponkilainen V, Huttunen T, Launonen A, Mattila VM. Incidence for volar locking plate removal following distal radius fracture surgery. Arch Orthop Trauma Surg. 2021 Aug;141(8):1297-1302.
• 26. Selles CA, Reerds STH, Roukema G, van der Vlies KH, Cleffken BI, Schep NWL. Relationship between plate removal and Soong grading following surgery for fractured distal radius. J Hand Surg Eur Vol. 2018 Feb;43(2):137-141.
• 27. Lutsky KF, Beredjiklian PK, Hioe S, Bilello J, Kim N, Matzon JL. Incidence of hardware removal following volar plate fixation of distal radius fracture. J Hand Surg Am 2015;40(12):2410–2415.
• 28. Rubensson CC, Ydreborg K, Boren L, Karlander LE. Flexor tendon repair after rupture caused by volar plate fixation of the distal radius. J Plast Surg Hand Surg 2015;49(2):112–115.
• 29. Lee JK, Lee Y, Kim C, Kim M, Han SH. Volar locking plate removal after distal radius fracture: a 10-year retrospective study. Arch Orthop Trauma Surg. 2021 Oct;141(10):1711-1719.
• 30. Vos DI, Verhofstad MH. Indications for implant removal after fracture healing: a review of the literature. Eur J Trauma Emerg Surg 2013;39(4):327–337.