Work

Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study

Year: 2025

Type: article

Abstract: INTRODUCTION: Flexor tenosynovitis is a well-recognized complication following volar plate fixation of distal radius fractures (DRFs). The aim of our study was to highlight the risk factors of flexor tenosynovitis. MATERIAL AND METHODS: We conducted a retrospective case-control study including 200 patients (50 cases and 150 controls) who underwent osteosynthesis with an Aptus™ volar locking plate. We analyzed demographic, surgical, and radiological factors associated with flexor tenosynovitis requiring hardware removal. Univariate and multivariate analyses were performed to identify independent risk factors. RESULTS: The prevalence of hardware removal for flexor tenosynovitis was 3.7% (50 patients). The mean time to symptom onset was 19.4 months ± 22.75 (range: 2-108), with an average delay of 3.8 months ±3.34 (range: 0.2-15) before hardware removal. In univariate analysis, significant risk factors included plate positioning in Soong C (p = 0.018), placement below the watershed line (p < 0.01), and postoperative immobilization with a plaster splint (p < 0.001). In multivariate analysis, only plate position relative to the watershed line (p = 0.038) and postoperative immobilization type (p < 0.001) remained significant. Pronator quadratus repair was more frequent in the control group (p = 0.046) but was not a significant protective factor in multivariate analysis (p = 0.11). CONCLUSION: Incorrect plate positioning, particularly relative to the Soong zones and watershed line, is a key risk factor for flexor tenosynovitis. Postoperative immobilization type may also play a role. Early plate removal should be considered in high-risk cases. LEVEL OF EVIDENCE: III; retrospective case control study.

Source: Orthopaedics & Traumatology Surgery & Research

DOI: 10.1016/j.otsr.2025.104347

Authors: Eléonore Canarelli, Clément Berry, Axel Van Vliet, Emmanuel David, Mathilde Léon

Institution: Centre Hospitalier Universitaire Amiens-Picardie

Language: English

Topic: Orthopedic Surgery and Rehabilitation

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,820