Incidence of Hardware Removal Following Volar Plate Fixation of Distal Radius Fracture.

PURPOSE: To assess the risk of tendon rupture or plate removal after volar plate fixation of distal radius fractures and to determine the incidence of hardware removal.

METHODS: We searched the surgical database of 5 attending hand surgeons at a single institution from 2009 to 2014. All patients who had undergone volar plate fixation were included. Patients were excluded if they underwent an alternate form of fixation, had less than 1 year of follow-up, or could not be reached for follow-up. Postoperative radiographs were examined for Soong grade, plate distance to the critical line, and plate distance to the volar rim. If patients had hardware removed, the reason for plate removal was identified. For all patients who did not have documented hardware removal at our institution, we placed a follow-up call to determine whether they had hardware removed elsewhere.

RESULTS: A total of 517 patients underwent volar plate fixation, 143 of whom did not have their hardware removed at our institution but could not be reached for follow-up. Of the remaining 374 patients, 37 (10%) had hardware removed. For group 1 (hardware retained), Soong grades were 13% grade 0, 85% grade 1, and 2% grade 2. For group 2 (hardware removed) the proportions were 11%, 76%, and 5%, respectively, and 8% undetermined. Mean plate distance to the critical line was significantly greater for group 2 (1.9 mm) compared with group 1 (1.2 mm). Mean plate distance to the volar rim did not differ (5.1 mm vs 5.3 mm).

CONCLUSIONS: The incidence of hardware removal in our series was 10%. The vast majority of patients had Soong grade 1 prominence. Patients who had hardware removed had a greater plate prominence volar to the critical line. Plate distance to the volar rim was not associated with removal.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.