JHS - 2026-08-18 - Journal Article
Radiographic Risk Factors for Flexor Tendon Ruptures Following Distal Radius Volar Plating.
Bachoura A, Matzon J, Ghayyad K, Ayodele T, Beredjiklian P, Tosti R
Topics
Key Takeaway
Capitate-to-axis-of-radius distance (CARD) was the only independent radiographic predictor of flexor tendon rupture after volar plating, with mean CARD 9.8 mm in rupture cases versus 3.5 mm in controls.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This case-control study investigated radiographic predictors of attritional flexor tendon rupture following volar locking plate fixation of distal radius fractures, comparing 27 rupture patients (mean age 66.9 years, 93% female) to 73 controls. Multivariable logistic regression identified CARD as the sole independent predictor of rupture when a plate was prominent, with rupture cases demonstrating a mean CARD of 9.8 mm versus 3.5 mm in controls. Soong class, radial inclination, and volar tilt were not independent predictors on multivariable analysis.
Key Limitation
The retrospective case-control design cannot establish causality, and the absence of a defined CARD threshold with sensitivity/specificity data limits direct intraoperative application.
Original Abstract
PURPOSE
To identify radiographic risk factors for flexor tendon ruptures following volar distal radius plating.
METHODS
This was a case-control study of 27 patients with complete flexor tendon rupture following volar plating of distal radius fractures and 73 control patients who underwent volar plating and did not rupture. Demographic and radiographic parameters were recorded including radial inclination, Soong class, lateral carpal alignment using the capitate-to-axis-of-radius distance (CARD), and volar tilt. Univariable and multivariable logistic regression modeling were used to determine independent predictors of rupture.
RESULTS
The rupture group consisted of 25 females and 2 males. The mean age at flexor tendon rupture was 66.9 years. When radiographic variables were included in the multivariable model, analysis revealed that CARD was the only significant predictor of tendon rupture when a plate was prominent. The mean CARD for the rupture group was 9.8 mm, with a range of 4.9-20 mm. The mean CARD for the control group was 3.5 mm, with a range of -2.9 mm to 11.6 mm.
CONCLUSION
In this analysis, CARD was the strongest predictor of attritional flexor tendon rupture in the setting of a prominent volar plate. Intraoperative correction of lateral carpal alignment based on CARD may decrease the risk of flexor tendon rupture when the plate is prominent.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic IV.