Purpose
This study sought to determine the impact of volar plate prominence on reoperation
rates after open reduction and internal fixation of distal radius fractures with volar
locking plates and to identify other factors associated with removal of hardware (ROH)
or a reoperation.
Methods
A retrospective study of patients who underwent distal radius open reduction and internal
fixation between 2012 and 2016 at 2 level I trauma centers was conducted. Plate prominence
was evaluated using the Soong index at the first postoperative visit. The details
of patient demographics, fracture and plate characteristics, complications, and reoperations
were recorded. Bivariate and multivariable regression analyses were used to identify
factors associated with increased rates of ROH and overall reoperation.
Results
A total of 732 (70.2%) of 1,042 patients completed follow-up at an average of 38.2
months, including 34 patients with bilateral operations, yielding 766 distal radius
fractures. One hundred sixteen (15.1%) patients underwent reoperation at an average
of 12.1 ± 13.6 months after the index surgery. Removal of hardware was the most commonly
performed reoperation (77 patients, 10%). The multivariable regression analysis revealed
significantly higher rates of ROH in Soong grade 1 or 2 patients (odds ratio 16, 95%
CI 5.8–47; odds ratio 44, 95% CI 14–140, respectively) than in Soong grade 0 patients.
Plate type, younger age, bilateral injuries, and concomitant procedures at the time
of the index operation were all associated with increased risk of ROH. There were
significant differences between individual surgeons the in rates of ROH (range 2.1%–22%)
and overall reoperation (range 5.2%–36%). Compared with other hand surgeons, fellowship-trained
hand surgeons had lower rates of ROH (8% vs 14%, respectively) and overall reoperation
(12% vs 22%, respectively).
Conclusions
The rates of ROH and overall reoperation increase with increasing Soong grade. Plate
type is independently predictive of future ROH. Older patients and those undergoing
open reduction and internal fixation experience lower rates of subsequent reoperation.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: September 03, 2021
Accepted:
June 6,
2021
Received:
February 13,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
