Trends in the Incidence of Flexor Tendinopathy after Surgical Fixation of Distal Radius Fractures: Analysis of a Population-Based Database.

Background: While early research identified features of volar locking plate design and placement as risk factors for flexor tendinopathy, temporal trends in rates of flexor tendinopathy have not been characterised despite the use of newer generations of volar plates and increased awareness of these risk factors. In this study, we tested the null hypothesis that there is no temporal trend in the incidence of flexor tendinopathy after surgical fixation of distal radius fractures. Methods: Using a national administrative claims database, we identified adults undergoing surgical fixation of isolated, closed distal radius fractures from 2011 to 2020. Patients were grouped by the quarter of the year they underwent surgery. We measured the incidence of flexor tendinopathy, malunion, nonunion and hardware removal at 1 and 2 years after the index procedure. We used a linear regression model to evaluate the association between time (per quarter) and the incidence of each complication. Results: We included 196,194 patients who underwent surgical fixation of distal radius fractures. With respect to 1-year outcomes, the incidence of flexor tendinopathy decreased by 0.6% per quarter, malunion increased by 0.8% per quarter, nonunion decreased by 2.1% per quarter and hardware removal increased by 0.5% per quarter. With respect to 2-year outcomes, the incidence of flexor tendinopathy decreased by 0.6% per quarter, malunion increased by 0.5% per quarter, nonunion decreased by 2.6% per quarter and hardware removal increased by 0.4% per quarter. Conclusions: The incidence of flexor tendinopathy after distal radius fracture fixation decreased from 2011 to 2020, which may reflect developments in volar plate design, improvements in implant selection and/or increased surgeon awareness of the risk of flexor tendinopathy. Further studies are needed to evaluate the aetiology of this trend. Level of Evidence: Level III (Therapeutic).