Fixation failure of a volar wrist plate following a fall from a standing height

Hind, Jamie; Kitsis, Christos; Ashwood, Neil

Item

Fixation failure of a volar wrist plate following a fall from a standing height

Abstract

Background: Distal radial fractures are common and contribute significantly to orthopaedic workload. This is a rare care where a volar locking plate, used to manage a previous wrist fracture, bent following a fall from standing height. This report discusses the mechanisms behind this injury and considers how this might have been prevented. We also discuss how hardware failure might impact on fracture repair in these uncommon injuries. Case Presentation: A lady was admitted with pain and a deformity to her left wrist following a fall. She had sustained a left wrist fracture 20 years previously, which was treated with a volar plate. An X-ray revealed a repeat fracture of her left wrist with bending of the metal work in situ. She was taken to theatre to remove the bent plate, reduce the fracture and fix the fracture with a new plate. She also required a fasciotomy and a carpel tunnel release; however, paresthesia over the thumb, middle and ring finger remained. Conclusion: Bending of metal work is a known complication; however this is not often following a single traumatic incident. The bending of the plate associated with the wrist fracture may have caused an inferior outcome in this case with threatening compartment syndrome and carpel tunnel syndrome. The bending of the metal work is most likely due to the older materials that were used. Newer materials are less likely to cause this response. It must be acknowledged that this injury can happen and does cause issue in management, not just operatively but pre-operatively as well, with increased pain and inability to manipulate the fracture under analgesia and sedation.