The Dorsal Tangential X-Ray View to Determine Dorsal Screw Penetration During Volar Plating of Distal Radius Fractures

Brunner, Alexander; Siebert, C. H.; Stieger, Claudia; Kastius, Alexander; Link, Björn‐Christian; Babst, Reto

doi:10.1016/j.jhsa.2014.10.021

Cited by 36 publications

(40 citation statements)

References 17 publications

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“…In the series of 25 consecutive patients, dorsal over-penetration of screws was discovered in two cases (8 %) (32). Brunner et al changed 11 screws of 93 (11.82 %) during surgery (33), and in the study by Vaiss et al it was 14.66 % (11 of 75 patients) (8). In the study by Joseph and Harvey, using the skyline view led to a change in screw length in 26.6 % of cases (4 of 15 patients) (25).…”

Section: Discussionmentioning

confidence: 98%

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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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Section: Discussionmentioning

confidence: 98%

“…Screw exchange during surgery after a skyline view varies from 5.17 % to 26.6 % (8,13,23,25,32,33). In a study by Rausch et al, 12 of 232 screws (5.17 %) were exchanged after obtaining a DTV (13).…”

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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“…18 years, (2) an isolated distal radius fracture confirmed by radiographs, and (3) patient indicated for ORIF of distal radius fracture with a volar plate. Exclusion criteria were (1) patient age <18 years, (2) presence of open fracture, (3) concomitant injury to either upper extremity, (4) functional deficit to either upper extremity, and/or (5) history of injury to either upper extremity. Patients were also excluded if supplemental fixation in addition to volar plate fixation was deemed necessary at the time of surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Open reduction and internal fixation (ORIF) is the mainstay of treatment for unstable distal radius fractures, with volar plating being the most common method of fixation. [2][3][4][5] While postoperative immobilization is standard practice, there is no consensus regarding the optimal splinting position to expedite return to function following this procedure. As a result, immobilization practices vary between institutions and are based largely on surgeon preference.…”

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confidence: 99%

Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

et al. 2018

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Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

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“…38,f The dorsal tangential view, which involves placing the wrist in maximal flexion and the forearm at a 15 angle to the vertical, is another method for detecting dorsal screw penetration. 39 In addition, dynamic fluoroscopy while assessing for crepitus during forearm rotation and wrist circumduction can be a useful adjunct to static fluoroscopic images. 40 Ljungquist et al 41 demonstrated that the depth of the lunate facet can be used as a marker to determine the longest screw length during volar plate fixation, minimizing the risk of extensor tendon irritation.…”

Section: Imagingmentioning

confidence: 99%