Frequency of third extensor compartment drill bit perforation in case of volar plating of radius fractures

Objective of this study was to explore how frequently the third extensor compartment was penetrated by drilling distal screw holes when doing volar plating of distal radius fractures. Four different plates were tested on altogether one hundred and sixty cadaver forearms. All distal holes were drilled; the exit holes were analyzed on the dorsal radius cortex. The overall penetration risk amounts to 43 percent. Differences could be observed: 3.5 LCP 4-hole locking T-plate: 20 percent, 3.5-LCP 3-hole locking plate: 42.5 percent, 2.4 volar LCP standard plate and the 2.4 volar LCP buttress plate: 55 percent. When doing volar plating of radius fractures, the surgeon should be aware of a considerable risk of penetrating the third extensor compartment. Extensor pollicis longus tendon may be harmed by drilling or by a prominent screw. Injuries to the extensor pollicis longus tendon may be avoided by not perforating the dorsal cortex, and downsizing the screws. Research in the literature reveals miscellaneous causes of extensor pollicis longus tendon ruptures following distal radius fractures (Al-Rashid et al. 2006, Arora et al. 2007, Benson et al. 2006, Douhit 2005, Failla et al. 1993, Heidemann et al. 2002, Hela et al. 1982, Hove 1994, Jenkins and Mackie 1988, Payne et al. 2000, Stahl and Wolf 1988, Wong-Chung and Quinlan 1989). Since volar plate fixation of distal radial fractures has become increasingly popular, extensor pollicis longus tendon ruptures seem to increase, whereas no evidence exists for this observation (Benson et al. 2006, Failla et al. 1993, Wong-Chung and Quinlan 1989). Objectives of this study were as to follows: 1. to assess how frequently the third extensor compartment is perforated by drilling; 2. to determine the differences between diverse implants; 3. to discuss potential solutions to avoid this complication.