Risk factors for complications following volar locking plate fixation of distal radial fractures - 01/01/25

Doi : 10.1016/j.otsr.2024.104151

Jean-Loup Tanner ^a, Antoine Bossée-Pilon ^a, Christophe Andro ^b, Dominique Le Nen ^a,^c, Rémi Di Francia ^a, Hoel Letissier ^a,^c,^d,⁎
^a Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, Brest 29200, France
^b Service de Chirurgie Orthopédique et Traumatologique, Hôpital Clermont-Tonnerre (Hôpital d’Instruction des Armées), Rue Colonel Fonferrier, Brest 29240, France
^c Université de Bretagne Occidentale, UBO, Brest 29200, France
^d LaTIM, INSERM, UMR 1101, SFR IBSAM, Avenue Foch, Brest 29200, France

^⁎Corresponding author at: Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, Brest 29200, France.Service de Chirurgie Orthopédique et TraumatologiqueHôpital de la Cavale BlancheBoulevard Tanguy PrigentBrest29200France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 01 January 2025

Abstract

Introduction

With the aging population comes an increase in the number of distal radial fractures and therefore in the number of cases requiring volar locking plate (VLP) fixation. The complication rates after VLP fixation vary greatly from one study to the next. Several authors have already focused on these complications and how to lower their rate.

The aim of this study was to identify risk factors for complications after VLP fixation of distal radial fractures that lead to implant removal.

Hypothesis

Implant removal (except systematic removal) after VLP fixation can be predicted by risk factors for complication.

Materials and methods

There were 2951 patients included in the study and divided into two groups: fixation without implant removal and fixation with implant removal. Then, intrinsic factors (age, sex, dominant side, tilt, type of fracture based on the AO classification (extra-articular – partial articular – complete articular – fracture); as well as one extrinsic factor (plate position according to the Soong classification compared to the watershed line) were identified. For all these factors, the relative risk (RR) was computed using univariate and multivariate models. The risk factors that reached statistical significance (p < 0.02) were used in the multivariate analysis.

Results

The univariate and multivariate analyses identified three risk factors for complications, i.e. implant removal: being under 62 years of age (RR = 1.99; CI 1.56−2.54, p < 0.0001), type 2R3C fracture according to the AO classification (RR = 1.50; CI 1.17−1.93, p = 0.0050) and Soong grade 2 plate position (RR = 1.73; 1.32−2.26, p < 0.0001).

Conclusion

Our study showed that plate position recorded as grade 2 was a risk factor for complications and therefore implant removal. This is an extrinsic factor that is implant and surgeon dependent. Moreover, intrinsic factors were also identified such as age and type of fracture. Assessing these risk factors after VLP fixation of distal radial fractures may lead to early detection of these complications and an opportunity to propose implant removal as a preventive measure.