778 Predicting Flexor Tendon Complications Following Volar Plate Fixation of Distal Radius Fractures

Introduction For distal radius fractures which are complex or unstable, volar locking plates are an effective means of fracture stabilisation, however patients may later develop flexor tendon complications. The Soong grading system was devised to determine which patients are most at risk of these by grading them between 0 (least likely) and 2 (most likely). Presently, however, this classification does not form part of our national guidelines. Aim We wanted to assess our current practice against the Soong classification, including testing its predictive value in identifying patients who developed flexor tendon issues. Method We performed a search of digital records for all patients who underwent volar plating following distal radius fractures in Norfolk and Norwich University Hospital between September 2022 and February 2023. Each fracture was graded using the post-operative X-rays and clinical outcomes were determined through review of clinic letters. Results 102 patients were initially identified although 3 were excluded due to the inadequacy of available imaging. Of the remaining 99 patients, the most common grade was grade 1 (47.5%), followed by grade 0 (44.4%) then grade 2 (8.1%). Flexor tendon complications occurred in 25% (2/8) of grade 2 patients and 2% (1/47) of grade 1 patients but never in grade 0 (0/44). Conclusions The Soong classification effectively identified patients at higher risk of flexor tendon complications. It remains unclear, however, what follow-up these patients should receive to mitigate this risk. This will require prospective studies, although close follow-up and early plate removal should be considered in the interim.