Dorsal Screw Penetration With the Use of Volar Plating of Distal Radius Fractures

Hill, Brian W.; Shakir, Irshad; Cannada, Lisa K.

doi:10.1097/bot.0000000000000361

Cited by 25 publications

(32 citation statements)

References 27 publications

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“…Two of the cadaveric studies also reported a nearly perfect interobserver agreement for the DTV (Ozer et al., 2012; Vernet et al., 2017). An important limitation of these cadaveric studies is that premade and preselected fluoroscopic images were presented to observers (Brunner et al., 2015; Hill et al., 2015; Ozer et al., 2012; Vernet et al., 2017) rather than views obtained by the observers themselves. This may explain the discrepancy between the accuracy of the cadaveric studies (Brunner et al., 2015; Joseph and Harvey, 2011; Marsland et al., 2014; Ozer and Toker, 2011) and the disappointing performance of the clinical series (Ganesh et al., 2016; Kiyak, 2018; Oc et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

Bergsma

Obdeijn

Janssen

et al. 2020

J Hand Surg Eur Vol

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In this cadaveric study of anterior plating of the distal radius, we aimed to determine the interobserver agreement and diagnostic performance for detecting dorsally protruding screws using the dorsal tangential radiographic view before and after specific training. Without prior instruction, 13 observers interpreted the dorsal tangential view of cadaveric specimens, in which anterior radial plates were placed. After seeing a training video on the dorsal tangential view, they repeated the task. Though we found that accuracy and interobserver agreement was lower than described in some other clinical series, training led to statistically significant improvements of (1) the interobserver agreement on the decision to exchange screws, (2) the self-confidence of the surgeon in obtaining adequate views, and (3) the number of fluoroscopic images required to obtain these views. After training, the number of protruding screws missed was reduced by 36%, but 7% of dorsally protruding screws was still missed.

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Section: Discussionmentioning

confidence: 99%

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

Bergsma

Obdeijn

Janssen

et al. 2020

J Hand Surg Eur Vol

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“…The fi rst (and mostly used) is with the supinated forearm inclined at 15° to the vertical X-ray beam with maximum wrist fl exion (8,12,13,21,(23)(24)(25)(26). The second is with a pronated forearm and horizontally placed fl uoroscope with the X-ray beam parallel to the dorsal aspect of the distal radius (9,27). In our study, we present the third technique, with a supinated forearm with the elbow at 90°, the wrist in maximal fl exion, and the fl uoroscope inclined at 15° to the X-ray beam.…”

Section: Discussionmentioning

confidence: 99%

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Kilian¹,

Simkovic²,

Zamborský³

et al. 2019

BLL

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PURPOSE: This study aimed to specify the optimal lengths of the distal locking screws (in a female population undergoing distal radius fracture fi xation with a volar locking plate) to avoid damaging the dorsal extensor tendon compartments while preserving stability. METHODS: Twenty-fi ve female adult patients underwent volar locking plate fi xation with four 2.4 mm locking screws inserted distally. Our modifi ed dorsal tangential fl uoroscopic view (DTV) was taken perioperatively followed by postoperative CT scans to compare the accuracy in determining the distal screw lengths. RESULTS: Our modifi ed DTV was 88 %, 84 %, 88 %, and 76 % sensitive in detecting screw lengths in the fi rst, second, third, and fourth distal plate holes, respectively. According to the CT scans, none of the screws were over-penetrated in the third dorsal compartment, over-penetration was found in the second and fourth dorsal compartment. The most-accurate screw lengths in the four most distal plate holes in female distal radius fracture are 14, 20, 20, and 20 mm from the radial to the ulnar aspect. CONCLUSION: In dorsal cortex comminution, when perioperative measuring is imprecise, inserting the mostsuitable distal locking screw for problematic hole and then applying our modifi ed DTV seems to be a simpler and safer option (Tab.

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“…In the cadaveric study of Hill, wrist radiographs in four planes, the 45° supination radiograph was reported to be the most sensitive to detect the dorsal cortex screw penetration [ 13 ]. In our study, we found that the dorsal tangential radiograph of the wrist was the most correlated with the USG examination.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation

Öç¹,

Kılınç²,

Gülcü³

et al. 2018

J Orthop Surg Res

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BackgroundComplications related to extensor tendons have begun to increase with the use of volar plates in the treatment of distal radius fractures. In this study, we aimed to compare four-plane radiography and ultrasonography in the evaluation of dorsal cortex screw penetration following volar plate fixation.MethodsWe recruited 47 patients (33 males, 14 females, mean age 37.4 years; range 18–58 years). To evaluate dorsal screw penetration in all patients, we performed radiographs at 45° pronation, 45° supination and obtained dorsal tangential graphs at maximum palmar flexion, and a wrist lateral radiograph. Wrist ultrasonography was performed in all patients.ResultsDorsal screw penetration was detected in 12 of the 47 patients undergoing VLP application. While there was > 2 mm screw penetration in seven patients, there was < 2 mm screw penetration in five patients. On four-plane radiographs, screw penetration > 2 mm was detected in seven patients and screw penetration < 2 mm was detected in two patients. On four-plane radiography, dorsal screw penetration was not detected in three out of five patients, who were shown to have < 2 mm screw penetration by ultrasonography. In addition to perioperative four-plane radiographs are also required to detect dorsal cortex penetration in patients undergoing VLP due to distal radius fracture. However, the detection of screw penetrations < 2 mm is more likely with ultrasonography compared to four-plane radiography.ConclusionWe recommend that dorsal cortex screw penetration should be evaluated with perioperative ultrasonography.Trial registrationResearch Registry, researchregistry3344, Registered 10 January 2017

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Dorsal Screw Penetration With the Use of Volar Plating of Distal Radius Fractures

Abstract: Clinicians should consider use of these views to evaluate dorsal screw penetration after volar plating but may opt to subtract a few millimeters from their measured screw lengths to avoid over penetration past the dorsal cortex.

Cited by 25 publications

References 27 publications

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation

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