Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study
Abstract
INTRODUCTION: Flexor tenosynovitis is a well-recognized complication following volar plate fixation of distal radius fractures (DRFs). The aim of our study was to highlight the risk factors of flexor tenosynovitis. MATERIAL AND METHODS: We conducted a retrospective case-control study including 200 patients (50 cases and 150 controls) who underwent osteosynthesis with an Aptus™ volar locking plate. We analyzed demographic, surgical, and radiological factors associated with flexor tenosynovitis requiring hardware removal. Univariate and multivariate analyses were performed to identify independent risk factors. RESULTS: The prevalence of hardware removal for flexor tenosynovitis was 3.7% (50 patients). The mean time to symptom onset was 19.4 months ± 22.75 (range: 2-108), with an average delay of 3.8 months ±3.34 (range: 0.2-15) before hardware removal. In univariate analysis, significant risk factors included plate positioning in Soong C (p = 0.018), placement below the watershed line (p < 0.01), and postoperative immobilization with a plaster splint (p < 0.001). In multivariate analysis, only plate position relative to the watershed line (p = 0.038) and postoperative immobilization type (p < 0.001) remained significant. Pronator quadratus repair was more frequent in the control group (p = 0.046) but was not a significant protective factor in multivariate analysis (p = 0.11). CONCLUSION: Incorrect plate positioning, particularly relative to the Soong zones and watershed line, is a key risk factor for flexor tenosynovitis. Postoperative immobilization type may also play a role. Early plate removal should be considered in high-risk cases. LEVEL OF EVIDENCE: III; retrospective case control study.
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BibTeX
@article{canarelli2026risk,
title = {{Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study}},
author = {Eléonore Canarelli and Clément Berry and Axel van Vliet and Emmanuel David and Mathilde Léon},
journal = {Orthopaedics \& Traumatology: Surgery \& Research},
year = {2026},
month = sep,
doi = {10.1016/j.otsr.2025.104347},
url = {https://hal.science/hal-05739173v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study
AU - Eléonore Canarelli
AU - Clément Berry
AU - Axel van Vliet
AU - Emmanuel David
AU - Mathilde Léon
PY - 2026
DA - 2026/09/04
JO - Orthopaedics & Traumatology: Surgery & Research
DO - 10.1016/j.otsr.2025.104347
UR - https://hal.science/hal-05739173v1
AB - INTRODUCTION: Flexor tenosynovitis is a well-recognized complication following volar plate fixation of distal radius fractures (DRFs). The aim of our study was to highlight the risk factors of flexor tenosynovitis. MATERIAL AND METHODS: We conducted a retrospective case-control study including 200 patients (50 cases and 150 controls) who underwent osteosynthesis with an Aptus™ volar locking plate. We analyzed demographic, surgical, and radiological factors associated with flexor tenosynovitis requiring hardware removal. Univariate and multivariate analyses were performed to identify independent risk factors. RESULTS: The prevalence of hardware removal for flexor tenosynovitis was 3.7% (50 patients). The mean time to symptom onset was 19.4 months ± 22.75 (range: 2-108), with an average delay of 3.8 months ±3.34 (range: 0.2-15) before hardware removal. In univariate analysis, significant risk factors included plate positioning in Soong C (p = 0.018), placement below the watershed line (p < 0.01), and postoperative immobilization with a plaster splint (p < 0.001). In multivariate analysis, only plate position relative to the watershed line (p = 0.038) and postoperative immobilization type (p < 0.001) remained significant. Pronator quadratus repair was more frequent in the control group (p = 0.046) but was not a significant protective factor in multivariate analysis (p = 0.11). CONCLUSION: Incorrect plate positioning, particularly relative to the Soong zones and watershed line, is a key risk factor for flexor tenosynovitis. Postoperative immobilization type may also play a role. Early plate removal should be considered in high-risk cases. LEVEL OF EVIDENCE: III; retrospective case control study.
SN - 1877-0568
SN - 1877-0568
ER -