Distal Radius Hairline Fractures – A New Hardware Related Complication

Background: Distal radius fractures (DRF) are frequently treated with locking-plate systems. There are well-documented intraoperative and postoperative complications of this technique. Proximal hairline longitudinal fractures surrounding the plate have recently been identified as a complication of this surgery. This study reports the incidence and clinical significance of this complication.

Methods: A total of 220 consecutive patients with DRF (225 fractures) underwent surgical treatment between 2013 and 2015 in our institution. Patients’ electronic medical records were reviewed. Patient`s demographics, preoperative, intraoperative and postoperative imaging parameters, treatment specifics and complications were recorded. Pre and postoperative imaging were evaluated by three independent reviewers.

Results: In 57 cases (25%) hairline fractures surrounding the proximal part of the plate were identified. Female gender, age above 59 and intra-articular DRF were identified as possible risk factors for this complication. Three patients (1.3%) required revision surgery due to peri-prosthetic fractures.

Conclusions: Hardware-related complications have been described in several published studies, but only few of them were linked to the plate design. Proximal hairline fracture is another complication related to the hardware, namely to the locking screws design. Manufacturers must continue the research to elucidate the exact mechanism of this fractures.