gms | German Medical Science

Objectives/Interrogation: Despite the increasing prevalence of longitudinal crack following volar locking plate fixation in our clinical experience, research on the topic remains sparse. The aim of this study was to examine the occurrence rate of the fine cracks and associated characteristics following volar locking plate fixation of the distal radius.

Methods: Using case records from Shizuoka Saiseikai General Hospital dated between March 2008 and March 2015, a total of 419 eligible adult distal radius fracture patients were identified. Standard anteroposterior postoperative radiographs were evaluated to classify longitudinal crack occurrence. The following data were recorded: plate type, surgeon experience at the time of surgery, patient age, sex, fracture type, and postoperative complications from the crack. Fractures were classified according to the AO/OTA classification system. Documented variables were compared between patients with longitudinal cracking and those without. Univariate analyses were conducted among each plate group.

Results and Conclusions: There were 38 confirmed cases of cracking (Acu-Loc: n=25, Acu-Loc 2: n=11, VA-TCP: n=2). Acu-Loc and Acu-Loc 2 were most common with rates of 13.0% and 27.5% respectively. Neither patient age nor gender was significantly associated with a particular type of plate. Along with patient age and sex, plate type was significantly associated with the occurrence of a longitudinal crack (p<0.05). Surgeon experience level did not affect the fine crack rates. All cracks healed within 4 to 6 weeks after the operation without any symptoms. Although we observed no severe complications following longitudinal cracks after volar plate fixation, surgeons and manufactures should still be cognizant of the potential complication. Intervention may not be necessary, but rare, severe implications may exist. Further study is required to understand the mechanism of the fine cracking and implement appropriate prevention techniques.