We appreciate the interest of Dr. Khanduja and colleagues in our study. In our experience, pi plates are somewhat difficult to remove after the development of extensor tenosynovitis. While we did not identify extensive fibrosis or scarring about the plates at the time of removal, tenosynovial proliferation and bony overgrowth over the implant did contribute to some difficulty at the time of implant removal. We have not considered elective implant removal in patients who have retained pi plates who have not developed evidence of tenosynovitis.

As discussed in the manuscript, we have moved toward the use of low profile plates, obviating the need for elective removal of the implant after fracture union.

With regard to the development of osteoarthrosis, no patients had significant radiographic evidence of degenerative changes at the radiocarpal joint at latest follow-up.

With respect to the development of degenerative and inflammatory changes about the extensor tendons, our patients who developed extensor tenosynovitis had their implants removed betweensix and fifteen months after surgery. The average time frame from fracture treatment to the development of extensor tenosynovitis requiring plate removal was 9.4 months.

Tamara D. Rozental, MD Pedro K. Beredjiklian, MD David J. Bozentka, MD

To the Editor:

We read with interest the article titled “Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal radius” by Rozental et al. (2003, 85A: 1956 – 1960). We congratulate you on achieving excellent results as documented with the Gartland and Werley scoring systems. We have treated these fractures at our institute with the AO Pi plate since 1997 and we were intrigued by some of you results. We would be grateful if the authors would respond to the following questions:

1. In our experience, it is very difficult to remove the implant if there is subsequent extensor tenosynovitis due to extensive fibrosis and tendon attrition. Did the authors find the same and do they consider elective removal of the implant after fracture union?

2. The authors report that all their patients achieved satisfactory reduction including <1mm of articular incongruity. However, it was not clear from their results how many of their patients showed any radiographic evidence of degenerative changes in the radiocarpal joint.

3. In our experience(submitted for publication) with seventeen patients who had fractures of the distal radius reconstructed with the AO pi plate, four patients developed extensor tenosynovitis between four and eight months after the plate was implanted. Did the authors notice a similar time frame for the development of extensor tenosynovitis?

References: 1. Knirk JL and Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986; 68(5): 647-59.