Impact of surgeon volume on the risk of complications following volar locking plating of unstable distal radius fracture

Complications following volar locking plating (VLP) of distal radius fracture (DRF) are frequent. Increasing evidence has shown an inverse relationship between increased surgeon experience and fewer complications in a variety of surgeries, and this study aimed to verify whether this relationship existed when specified in the DRF surgically treated with VLP. Patients with an unstable DRF surgically treated by VLP in our institution between January 2016 and December 2021 were included. Data on complication were obtained by inquiring the medical charts and the follow-up register, also the covariables for adjustment. Surgeon volume was defined by the number of VLP procedures within 12 months preceding index surgery, and its optimal cutoff was determined by constructing the receiver operator characteristic, in which high- or low-volume was dichotomized. The relationship between surgeon volume and risk of complications was investigated using a univariate and multivariate logistic regression model. Five hundred sixty-one patients were enrolled and operated on by 21 surgeons, with a median of 14 for each surgeon. The 1-year complication rate was 13.5%, with tenosynovitis (4.1%), carpal tunnel syndrome (2.7%), and complex regional pain syndrome type 1 (2.3%) being the most common. The optimal cutoff was 8, and 69.2% of patients were operated by high-volume surgeons, with a 7.5% incidence; 30.8% of the patients were operated by low-volume surgeons, with a 27.2% incidence. Low-volume was associated with an increase in the risk of general complications by 4.8 times (95% confidential interval, 2.9-8.2). Subgroup analyses showed that this trend was intensified for AO type C fracture (odds ratio, 5.9), slightly mitigated for type B (odds ratio, 3.7), but not significant for type A. The finding highlighted the need to maintain 8 cases/year to improve the complications of DRFs, and for severe cases, centralized treatment is recommended.