Two Case Studies of Patients with Flexor Tendon Injury Following Locked Volar PlatingWhen a patient breaks the radius bone (bone closest to the wrist), sometimes it is necessary for surgery to implant a plate to strengthen the bone. Over time, the metal plates have evolved to be more effective and to limit any side effects or problems later from the surgery.
This article presents two patients who developed flexor tendon injuries following insertion of a volar plate. The first patient, a 57-year-old woman complained of pain three months following initial surgery to repair her fracture. She complained of pain in the wrist and forearm, and wrist flexibility was limited. A volar plate was implanted and the patient recovered well, with no complaints of pain following surgery.
After eight months, the patient returned, complaining of pain in the wrist and difficult pinching and writing, along with weakness. Upon examination of the x-rays, the surgeon noted that the bone had healed well, but the plate appeared to be out of position. During surgery, it was found that the plate had frayed the tendon. This was repaired and the patient returned full strength by six weeks following the repair.
The second patient was a 51-year-old woman who had her wrist fracture repaired immediately with a plate. The patient had full use of her hand and was pain free at eight weeks following the surgery. Six months after the surgery, the patient returned with complaints of thumb pain and loss of function. She was also unable to flex her thumb. X-rays showed healing of the bone, but the plate was moved a bit to the side.
During surgery, the surgeon discovered that the tendon had ruptured. The plate was removed and the tendon was repaired, and the patient regained full use of her hand with no pain.
The authors write that because these tendon injuries are possible due to the positioning of the plate, patients should be warned before surgery of the possibility of tendon injury and the resulting need for surgical repair. They suggest that such patients be followed for at least one year following surgery.
Andrew W. Cross, MD, and Christopher C. Schmidt, MD. Flexor Tendon Injuries Following Locked Volar Plating of Distal Radius Fractures. In Journal of Hand Surgery. Feb. 2008. Vol. 33A. Pp. 164-167.
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