The relationship between plate prominence and need for removal after volar plate osteosynthesis of distal radius fractures.

PURPOSE: This study aimed to assess the incidence of plate-related complications and the need for plate removal after volar plate osteosynthesis of the distal radius in relation to Soong classification. METHODS: All consecutive patients (age > 16 years) in our level II trauma center treated with plate osteosynthesis for distal radius fractures from January 2017 until June 2019 were retrospectively evaluated. The main outcome measures were volar plate positioning according to Soong classification and incidence of plate removal. In addition, the incidence of tendon ruptures, reasons for volar plate removal, and improvement of complaints after removal were evaluated. RESULTS: The overall incidence of plate removal in the 336 included patients was 16.9% (n = 57). Removal incidence in Soong 2 plates (28.2%) was significantly higher compared to Soong 0 and 1 plates (8.0% and 14.4%, respectively), P = 0.003. Multivariable binary logistic regression analysis showed Soong grade 2 as an independent predictor for plate removal, OR 4.3 (95% CI 1.4-13.7, P = 0.013). Four cases of flexor and four cases of extensor tendon rupture were reported, all in Soong 2 grade plating. The main reasons for volar plate removal were pain (42%) and reduced functionality (12%). In cases where pain was the main reason for removal, 81% of patients reported a decrease in pain during follow-up after surgery. CONCLUSIONS: This study suggests an association between plate prominence graded by Soong and plate removal using a single plating system. Plate prominence should be reduced in volar plating whenever technically feasible.

[A 21-year-old man with a swelling on the forearm]. / Een jongeman met een zwelling op de onderarm.

A 21-year-old man presented at the radiology department with a focal swelling on the right forearm that became apparent when making a fist. A dynamic ultrasound assessment revealed a defect of the fascia overlying the flexor muscles, through which a herniation of muscle tissue occurs during contraction.