gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Should I stay or should I go – how safe is the routine removal of volar locking plates after healed fractures of the distal radius?

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  • presenting/speaker Senat Krasnici - Department of Trauma and Reconstructive Surgery, Johanniter Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
  • Kay Krüger - Department of Trauma and Reconstructive Surgery, Johanniter Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
  • Wolfgang Ertel - Department of Orthopedics, Trauma and Reconstructive Surgery, University Charité Medical School, Campus Benjamin Franklin, Berlin, Germany
  • Isabella Fassola - Plastic, Aesthetic, Hand and Reconstructive Micro Surgery, Klinikum Ernst von Bergmann GmbH, Potsdam, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1777

doi: 10.3205/19ifssh0539, urn:nbn:de:0183-19ifssh05391

Published: February 6, 2020

© 2020 Krasnici et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: We present our experience with removal of locked volar distal radius plates and screws and note the different complication rates between medically indicated (MI) and non-medically indicated (NMI) hardware removal.

Methods: We retrospectively reviewed all distal radius fractures treated with volar locking plates at our institution from 2003 to 2018 (1.473 cases) and identified those who underwent hardware removal. Patients were divided into two groups (MI and NMI) according to their indication for implant removal.

Results: A total of 66 patients (42 women, 24 men) underwent hardware removal (incidence 4.5%). The average age was 53.3 years (min 19, max 87). The MI group consisted of 31 patients (47%) and the NMI group of 35 patients (53%). According to the AO classification, there were 18 type A (27.3%), 7 type B (10.6%), and 41 type C (62.1%) distal radius fractures. The average interval between initial trauma and primary osteosynthesis was 5.6 days (min 0, max 100).

The most common indications for hardware removal in the MI group were limited range of motion (n = 14), post-traumatic CTS (n = 6), ulnar impaction syndrome (n = 4), mechanical problems (n = 3), pain with identifiable source (n = 3), and tenosynovitis (n = 1), while in the NMI group the indications were patient's wish (n = 33) and pain without an identifiable source (n = 2). The mean length of implantation was 63.8 weeks (range, 9-557). Overall there were 5 complications (4 persistent pain, 1 hematoma requiring revision) (incidence 7.6%). All complications occurred in the MI group (16.1%) (p = .02). There were no statistically significant difference between the two groups in terms of age (p = .70), gender distribution (p = .89), type of AO fracture (p = .87), time interval between injury and initial osteosynthesis (p = .29), and time between osteosynthesis and hardware removal (p = .34).

Conclusion: We found statistically significant difference in the rate of complication between medically and non-medically indicated hardware removal following volar locking plate fixation of distal radius fracture. Non-medically indicated hardware removal of a healed distal radius fracture treated with volar locking plate is a safe procedure.