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Aspects of Current Management: N. D. Downing and A. Karantana A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br 2008; 90-B: 1271-1275 [Abstract] [Full text] [PDF]

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Re-operation for metalwork complications following the use of volar locking plates for distal radius

Ajay Sahu, C.P. Charalambous, M.J. Ravenscroft   (21 November 2008)

Re-operation for metalwork complications following the use of volar locking plates for distal radius 21 November 2008
Ajay Sahu, Clinical Research Fellow Stepping Hill Hospital, Stockport, Manchester, UK, C.P. Charalambous, M.J. Ravenscroft Send letter to journal: Re: Re-operation for metalwork complications following the use of volar locking plates for distal radius Ajay.Sahu{at}stockport.nhs.uk Ajay Sahu, et al.	Sir, We read this paper with interest. The study raised the debate about whether the current overzealous use of volar locking plates for management of these fractures is based on any validated patient-derived outcome measures. We strongly agree with the authors' view on this issue that there is no robust evidence that surgical management of fractures of the distal radius will produce consistently better long-term results. Downing and Karantana have mentioned a few studies on volar locking plates with overall complication rates varying between 8% and 27%. These studies have included direct (metalwork-related) and indirect (soft tissue problems due to metalwork) complications secondary to volar locking plates. None of the studies separately mention the re-operation rate for metalwork complications. We audited 114 distal radius fractures treated with volar locking plating in 2007 at our hospital in the United Kingdom. In our series, 12 cases (10%) underwent further surgery for metalwork-related complications mainly for screw protrusion into the radiocarpal joint following fracture collapse (eight cases). In two cases, the metaphyseal screws loosened and backed out. There were two cases where tendon problems were observed due to irritation by the metalwork requiring its removal. Our results suggest that volar locking plates are associated with a high rate of metalwork-related complications requiring further surgery. These complications must be taken into account in deciding which implant to be used. We feel that for a common fracture such as that of the distal radius an ideal implant should be easy to use and have a low complication rate. We would welcome the authors’ comments on this point. A. Sahu, Clinical Research Fellow, C.P. Charalambous, M.J. Ravenscroft, Stepping Hill Hospital, Stockport, Manchester, UK.