The incidence and cause of reoperation for complications after volar locking plate fixation of distal radial fractures.

Background: Distal radial fractures are the most common upper extremity fractures. Volar locking plate fixation has become the standard surgical treatment, providing stable angular fixation, early rehabilitation, and effective support for comminuted and osteopenic bones. This study aimed to analyze the incidence and causes of major complications requiring secondary surgeries following volar plating for distal radial fractures and to investigate the correlation between demographic factors and postoperative outcomes, including major complications and reoperation.

Methods: This retrospective study enrolled 1073 distal radial fracture cases from 1047 patients at a trauma medical center between January 2015 and June 2021. Patients under 18 years old and whose follow-up was less than 6 months or ended before the surgeon concluded their treatment were excluded. We also examined reasons for device removal, reoperation, and complications following volar plating, specifically identifying major complications requiring additional operations.

Results: Among the 1073 distal radial fracture cases, 160 patients with 168 fractures underwent secondary orthopedic operations after volar plating. Ultimately, 33 cases required additional operations for major complications, resulting in a reoperation rate of 22 % and a major complication rate of 5.3 %. Major complications included: triangular fibrocartilage complex tear, deep infection, carpal tunnel syndrome, flexor pollicis longus injury and extensor pollicis longus injury, screw penetration or loosening, and complex regional pain syndrome. Logistic regression showed a higher reoperation incidence in males and patients under 65, although age and sex were not associated with major complications.

Conclusions: This study outlined the incidence and causes of reoperation for complications following volar plating for distal radial fractures. Surgeons could benefit from preoperative counseling on potential complications and early identification and treatment. As age and sex were unrelated to postoperative complications, surgeons may consider factors like fracture patterns, functional demands, and baseline activity when determining treatment options with patients.