Artikel
The Soong Criteria and the risk of flexor tendon rupture post volar plate application. What is the associated risk of the loss of the normal volar tilt?
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Autoren
-
Jesse Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, United States
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Purpose: The seminal investigation by Soong et al. identified radiographic criteria for the risk of tendon irritation post volar plate application. Using the ICUC data base of consecutively treated distal radius fractures with volar plate treatment, we evaluated both standard xrays and postoperative CT scans to address several questions:
- 1.
- Which critical point on the volar rim of the radius should be used?
- 2.
- Is loss of the normal volar tilt a risk factor?
- 3.
- Should prominent plates be removed even without symptoms?
Materials and Methods: 203 consecutive patients treated for a distal radius fracture with a volar plate identified 6 with flexor pollicis injury (4 complete and 2 incomplete rupture). Four patients were female and 2 male with an average age of 62.5 years (range 55-80 yrs). 3 surgeons independently evaluated the xrays and CT scans.
Results: The average time from plate placement to tendon disruption was 115 weeks (range 29-251 weeks). Of note, 3 patients presented very late at 116, 168, and 251 weeks respectively. Two of the 6 patients were asymptomatic prior to rupture. The CT scan proved more accurate than standard xrays when measuring the Soong criteria due, in part, to two volar points of the volar rim of the radius with Soong 2 seen in each CT while the xrays were rated as Soong 1 in 3 and 2 in 3. Three patients had 0 deg volar, 1 8 deg, and 2 dorsal of 2 and 10 deg.
Conclusions: Plate prominence especially combined with loss of volar tilt should be a warning sign of risk of tendon rupture and we believe those patients should have elective plate removal.
