Risk for Flexor Pollicis Longus Rupture after Volar Lock Plating for Distal Radius Fracture Lasts Over a Decade

Objectives: Volar locking plate (VLP) fixation is a very common procedure due to the high incidence of distal radius fractures (DRFs). Attritional flexor tendon rupture is a rare, but recognized complication after VLP fixation. There is no current consensus to prevent the condition. Our objective was to highlight the long-term risk for flexor tendon rupture after VLP fixation.

Methods: We conducted a retrospective single-center review of patients with attritional flexor tendon rupture after VLP fixation for DRFs between 2016 and 2021. Patient demographics, DRF details including AO fracture classification, Soong grading and tendon reconstruction were collected. Thumb interphalangeal joint (IPJ) motion and Kapandji score were used as outcome measures for the tendon reconstruction.

Results: We identified five patients with attritional flexor pollicis longus (FPL) ruptures. The median age of the patients at the time of DRF was 48 (34-56) years. All VLP fixations were Soong grade 2. Median time from VLP fixation to tendon rupture was 7 (3-14) years. Longest surgery-to-rupture interval was 14 years. One rupture was treated conservatively. Four were reconstructed using palmaris longus (PL) tendon graft. Thumb IPJ active range of motion median was 48 (20-55) degrees and Kapandji score 9/10 (7-9/10).

Conclusion: Older generation VLP fixations with Soong grade 2 pose a long-term risk for attritional FPL rupture, which can be reconstructed with PL tendon graft with fair to good outcomes.