Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

• Main Authors: Ozer Kagan, Cao Jue
• Format: Article
• Language: English
• Published: BMC 2010-11-01
• Series: Patient Safety in Surgery
• Online Access: http://www.pssjournal.com/content/4/1/19

<p>Abstract</p> <p>Background</p> <p>Volar locking plates provide significant structural stability to the distal radius. Failure of a volar locked plating is a rarely reported complication in the literature.</p> <p>Case Presentation</p> <p>A 40 year-old, obese female patient who presented with a displaced extraarticular distal radius fracture, underwent open reduction and internal fixation of the fracture using a volar locking plate. Radiographs taken at 10 weeks postoperatively showed failure of fixation with breakage of the four distal locking screws. A hardware removal was performed at 6 months, and the patient was then lost to follow-up. She presented again at 18 months after the first surgery, with significant pain, and radiographic signs of a radial collapse and a fracture-nonunion. A total wrist fusion was performed as the method of choice at that point in time.</p> <p>Conclusion</p> <p>Volar locked plating represents the new "gold standard" of distal radius fracture fixation. However, despite the stability provided by locking plates, hardware failure may occur and lead to a cascade of complications which will ultimately require a wrist fusion, as outlined in this case report. Additional structural support by bone grafting may be needed in selected cases of volar locked plating, particularly in patients with a high risk of developing a fracture-nonunion.</p>