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

hand surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    • Lesion/Transection of radial artery, median nerve or palmar branch of median nerve
    • Tendon injury
    • incomplete reduction

    Management

    • primary microsurgical nerve or arterial suture for nerve or arterial injury
    • Tendon reconstruction
    • controlled retraction of the soft tissues with the wound retractor to avoid traction injury to the median nerve and its branches
    • in case of incomplete reduction, consider changing the procedure (external fixator or internal [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
    • in case of infection and compartment syndrome, immediate surgical revision

    Late Complications

    • posttraumatic 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
    • persistent restriction of movement of the wrist and fingers
    • Loosening of the 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 arthrosis 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, splint supply, desensitization)
    • for loosening of the osteosynthesis material or tendon irritation, partial or complete removal of the material
    • for EPL rupture, reconstruction of the tendon using palmaris longus graft (within the first 6 months after rupture event) or as EIP transfer (≥ 6 months)
    • for FPL rupture: reconstruction using 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, radius corrective osteotomy with bone graft or for pure ulnar advancement, ulnar shortening
    • for radiocarpal arthrosis, salvage procedures (RSL fusion, complete wrist arthrodesis) after exhaustion of all conservative measures
    • for pseudarthrosis, re-osteosynthesis with bone graft
    • for CRPS, appropriate therapy of the disease (see specialist literature)