Volar Plate Impingement Following Scaphoid Fracture Nonunion Surgery Using a Volar Locking Plate: A Retrospective...

Area of Science:

• Orthopedic Surgery
• Radiology
• Hand Surgery

Background:

• Scaphoid fracture nonunion often requires surgical intervention.
• Volar locking plates are a common fixation method.
• Concerns exist regarding plate impingement and removal post-surgery.

Purpose of the Study:

• To assess volar plate impingement (VPI) after scaphoid fracture fixation.
• To develop and apply a classification system for VPI based on imaging.
• To correlate imaging findings with the need for plate removal.

Main Methods:

• Retrospective review of 21 patients undergoing volar plate fixation for scaphoid nonunion.
• Independent review of CT scans and radiographs by three surgeons.
• Classification of VPI into four grades: none, mild, moderate, and severe.
• Correlation of VPI grade with symptomatic plate removal.

Main Results:

• VPI was detected in 16 out of 21 patients on CT scans.
• CT revealed a spectrum of VPI from mild wear to severe joint blocking.
• Only two patients showed impingement on radiographs.
• Eight patients (38%) underwent plate removal due to symptomatic impingement.

Conclusions:

• Volar plate impingement is a frequent finding after volar locked plating for scaphoid fractures.
• CT scans are more sensitive than radiographs for diagnosing VPI.
• Plate removal decisions should be guided by clinical symptoms, with CT aiding diagnosis.