The Relationship Between Soong Classification and Fracture Characteristics With Implant Removal for Distal Radius Fractures: a Comparative Study of 795 Cases

Abstract

Introduction: Although there is no consensus in the literature, it is believed that the Soong classification system and fracture pattern are risk factors for plate removal in distal radius fractures. Hypothesis: The aim of this large-scale study was to evaluate the relationship between Soong classification, fracture pattern, and implant removal in distal radius fractures. Materials and methods: We retrospectively evaluated 795 patients who underwent surgery using a volar locking plate for distal radius fractures at our clinic between 2005 and 2022. The patients were divided into two groups: implant removed, and implant retained. The groups were examined for demographic data, follow-up periods, fracture classifications, and radiological parameters. Additionally, the patients were divided into groups and compared according to the Soong classification, which was determined according to implant placement. Indications for implant removal were also included in this study, and their relationships with other parameters were evaluated. Results: A total of 123 and 672 patients were included in the implant removed and retained groups, respectively. The average age of the implant removed group was significantly lower (p = 0.005). There were no significant differences between the two groups in terms of fracture classification or other radiological parameters. In the implant removed group, the rate of grade 2, according to the Soong classification, was statistically higher than that in the other groups (p = 0.019). Flexor tenosynovitis was the most common reason for implant removal. Conclusion: The Soong classification system is an important risk factor associated with implant removal. This risk may increase, particularly among young patients. Surgeons should consider placing the distal radius locking plate as proximally as possible to reduce the frequency of implant removal. Level of evidence: III; retrospective comparative study © 2025 Elsevier Masson SAS