Retrospective two-institution study of 168 volar-plated distal radius fractures comparing flexor tendon rupture rates between two plate designs. The study introduces the Soong grading system — a three-grade radiographic classification of plate prominence relative to the watershed line on the postoperative lateral radiograph. The central question: does plate design, independent of surgeon technique, drive this complication?
On every postoperative lateral after volar distal radius plating, draw the critical line tangent to the volar rim and assign a Soong grade before the patient leaves follow-up.
If the plate is Grade 2, the tendon is riding directly over the implant edge with every wrist flexion. Counsel the patient about rupture risk, discuss elective hardware removal, and build in long-term follow-up — symptoms can appear more than 3 years after surgery.
This paper reframes tendon rupture as a plate-design problem, not purely a positioning problem. 63% of one implant's plates were Grade 2 by design. Knowing your implant's profile at the radial styloid is part of informed consent. The FPL is the most commonly ruptured tendon in this setting. Any patient with new thumb flexion weakness after volar plating. Even years out. Needs urgent evaluation.
Retrospective two-institution study of 168 volar-plated distal radius fractures comparing flexor tendon rupture rates between two plate designs. The study introduces the Soong grading system — a three-grade radiographic classification of plate prominence relative to the watershed line on the postoperative lateral radiograph. The central question: does plate design, independent of surgeon technique, drive this complication?
On every postoperative lateral after volar distal radius plating, draw the critical line tangent to the volar rim and assign a Soong grade before the patient leaves follow-up.
If the plate is Grade 2, the tendon is riding directly over the implant edge with every wrist flexion. Counsel the patient about rupture risk, discuss elective hardware removal, and build in long-term follow-up — symptoms can appear more than 3 years after surgery.
This paper reframes tendon rupture as a plate-design problem, not purely a positioning problem. 63% of one implant's plates were Grade 2 by design. Knowing your implant's profile at the radial styloid is part of informed consent. The FPL is the most commonly ruptured tendon in this setting. Any patient with new thumb flexion weakness after volar plating. Even years out. Needs urgent evaluation.