Prospective multicenter study of 114 patients with unstable dorsally displaced distal radius fractures treated with volar locking plates (2.4 mm LCP, Synthes), with minimum 12-month follow-up. Designed to characterize the full complication profile of this increasingly popular fixation strategy, with special attention to tendon and hardware-related problems.
The watershed line is not just an anatomic landmark — it is a binary risk threshold. Every patient in this series whose plate crossed it developed a flexor tendon complication. Keep the plate proximal to this ridge, where the pronator quadratus can act as a buffer between the implant and the FPL.
When you see early tenosynovitis on follow-up imaging or exam, remove the hardware before the tendon ruptures. All 13 patients with tenosynovitis in this study underwent prompt implant removal; the two FPL ruptures occurred in patients with an unlocked, protruding screw. The cost of delayed hardware removal is a two-stage tendon reconstruction with palmaris longus graft.
For distal screws, do not trust fluoroscopy alone to confirm length. The triangular dorsal cortex geometry means peripheral screws are naturally shorter than central ones, and fluoroscopic images routinely miss dorsal cortex violation. Downsize by 2 mm as a default.
This paper is also a reminder that no single plate system works for every distal radius fracture pattern. Type C3 fractures and very distal fractures may require fragment-specific fixation, dorsal plating, or bone graft rather than a standard volar LCP construct.
Prospective multicenter study of 114 patients with unstable dorsally displaced distal radius fractures treated with volar locking plates (2.4 mm LCP, Synthes), with minimum 12-month follow-up. Designed to characterize the full complication profile of this increasingly popular fixation strategy, with special attention to tendon and hardware-related problems.
The watershed line is not just an anatomic landmark — it is a binary risk threshold. Every patient in this series whose plate crossed it developed a flexor tendon complication. Keep the plate proximal to this ridge, where the pronator quadratus can act as a buffer between the implant and the FPL.
When you see early tenosynovitis on follow-up imaging or exam, remove the hardware before the tendon ruptures. All 13 patients with tenosynovitis in this study underwent prompt implant removal; the two FPL ruptures occurred in patients with an unlocked, protruding screw. The cost of delayed hardware removal is a two-stage tendon reconstruction with palmaris longus graft.
For distal screws, do not trust fluoroscopy alone to confirm length. The triangular dorsal cortex geometry means peripheral screws are naturally shorter than central ones, and fluoroscopic images routinely miss dorsal cortex violation. Downsize by 2 mm as a default.
This paper is also a reminder that no single plate system works for every distal radius fracture pattern. Type C3 fractures and very distal fractures may require fragment-specific fixation, dorsal plating, or bone graft rather than a standard volar LCP construct.