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Complications - Angle-stable palmar plate osteosynthesis of a distal radius fracture on the right

hand surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    • Lesion/Transection of the radial artery, median nerve, or palmar branch of the median nerve
    • Tendon injury
    • Incomplete reposition

    Management

    • Primary microsurgical nerve or artery suture in case of nerve or artery injury
    • Tendon reconstruction
    • Controlled retention of soft tissues with the wound hook to avoid traction injury to the median nerve and its branches
    • Consider changing the procedure in case of incomplete reposition (external fixator or internal dorsal spanning plate)

  2. Postoperative complications

    Acute Complications

    • Bleeding/Hematoma
    • Infection/Wound healing disorder (0.3-2%)
    • Compartment syndrome

    Management

    • if necessary, evacuation of the hematoma
    • immediate surgical revision in case of infection and compartment syndrome

    Late Complications

    • Post-traumatic carpal tunnel syndrome (0.5-22%)
    • Dysesthesia in the area of the thenar eminence due to traction injury of the palmar branch of the median nerve
    • Permanent restriction of movement of the wrist and fingers
    • Loosening of osteosynthesis material
    • Tenosynovitis due to protruding osteosynthesis material (palmar plate, dorsally too long screws)
    • Keloid formation
    • EPL rupture (4.4-8.6%)
    • FPL rupture (0-12%)
    • Fracture healed in malposition (Malunion)
    • Pseudarthrosis
    • Radiocarpal arthritis in 2-30%, with persistent joint step of ≥ 2 mm in 90%
    • CRPS (Sudeck's disease) 3%

    Management

    • for CTS: open neurolysis
    • for movement restriction, dysesthesia, or scar complaints, hand therapy measures (physiotherapy, splinting, desensitization)
    • for loosening of osteosynthesis material or tendon irritation, partial or complete removal of the material
    • for EPL rupture, reconstruction of the tendon with palmaris longus graft (within the first 6 months after rupture event) or as EIP transfer (≥ 6 months)
    • for FPL rupture: reconstruction with palmaris longus graft or FDS transfer (ring finger)
    • for intra-articular malposition, open-wedge osteotomy with bone graft and special plate osteosynthesis
    • for extra-articular malposition, radial corrective osteotomy with bone graft or pure ulnar advancement, ulnar shortening
    • for radiocarpal arthritis, salvage procedures (RSL fusion, complete wrist fusion) after exhausting all conservative measures
    • for pseudarthrosis, re-osteosynthesis with bone graft
    • for CRPS, appropriate treatment of the disease (see specialist literature)