gms | German Medical Science

Objectives: To document a new complication in volar locking plating (VLP) of distal radius fractures (DRFs) with Acu-loc®(FGP) or Acu-loc 2®(SGP) (Acumed, Hillsboro, OR) wrist plating systems.

Methods: A retrospective review was carried out of patients with DRFs treated with FGP or SGP in our institution between January 2007 and January 2014. All patients were operated by the same team of surgeons. Patients younger than 18 years old, operated with other implants, had longitudinal fracture lines (LFLs) in preop x rays were excluded. For radiological evaluation, the x-rays taken at the time of injury, postoperative x-rays, and those taken at the time of follow-ups were assessed. All radiographs were examined by three independent surgeons. A LFL extending plate proximal in any of postop x rays was cross examined among the surgeons, and accepted as a complication when all of them conformed. (Figure 1)

In addition to descriptive analysis for age distribution; T tests were used for age means and LFL observation. Correlations of age group, and LFL observation were evaluated with chi-square test.

Results and Conclusion: Department's surgical database identified 223 patients (123 female, 100 male) (median age 50.7; range, 19-89 years); 124 of them were operated with FGP and 99 were with SGP (Table 1). Mean follow up was 37.9 months (range,12 to 80 months).A LFL extending plate proximal in any of postop x rays were observed in 36 patients (mean age:66.3). There were 187 patients without a LFL (mean age: 47.67) There was a statistically significant difference between mean ages of LFL group and the other patients (p <0.05).

Age group descriptives for fracture group patient exhibit a lower bound of 62.55 years in a 95% confidence interval for mean. Thus, patients over 60 years old were re-evaluated. There were 68 patients (55 females, 13 males) over 60 years of age (mean: 69.6, range: 60-89 years) in both implant groups. Twenty eight of them had LFLs (Table2). Correlation between categorical (age over 60 and LFLs) variables was significant (p<0.05).

By aging; thinning and weakening near cortex may be more brittle. When plate is reduced on the bone with a nonlocking screw, the conical head of diaphyseal locking screws can brim over plate thickness and insert into near cortex acting as a screwing wedge. Additional divergent configuration may promote this effect and crack cortex.