J Wrist Surg 2019; 08(04): 300-304
DOI: 10.1055/s-0039-1685204
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intraoperative Tilted Posteroanterior View for the Measurement of Distal Radius Articular Step-Off

Steven Beldner
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Black Hall, New York, New York
,
Remy V. Rabinovich
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Black Hall, New York, New York
,
Daniel B. Polatsch
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, Black Hall, New York, New York
› Author Affiliations
Further Information

Publication History

06 January 2019

27 February 2019

Publication Date:
16 April 2019 (online)

Abstract

The purpose of this study is to more accurately determine distal radius articular step-off in the posteroanterior (PA) view. A cadaveric forearm was osteotomized with varying amounts of articular displacement. A second osteotomy was made through the distal radius metaphysis to create four positions of tilt in the lateral plane (5° and 15° dorsal tilt; 5° and 15° volar tilt). Using fluoroscopy, the beam was positioned in the lateral plane from 25° volar to 20° dorsal, separated by 5° increments, obtaining modified PA images of the distal radius in its various configurations. The images were randomly evaluated for step-off by three hand surgeons in a blinded fashion. Statistical analysis was performed to determine the accuracy between estimated and actual step-off and was demonstrated to be greater when the PA view was parallel to the distal radius tilt in the lateral plane, for all four configurations of distal radius tilt. Data pertaining to the distal radius with 0 mm of step-off did not demonstrate the PA view, parallel to the distal radius tilt, to be superior than the PA views not parallel to the tilt; reaffirming that with anatomic reduction, any fluoroscopic image exhibits good alignment. This study confirms that the most accurate method of accessing PA step-off is to first determine the tilt of the radius on a lateral film and then align the beam in the PA plane to match this tilt.

 
  • References

  • 1 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (05) 647-659
  • 2 Gilula LA, Destouet JM, Weeks PM, Young LV, Wray RC. Roentgenographic diagnosis of the painful wrist. Clin Orthop Relat Res 1984; (187) 52-64
  • 3 Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994; 19 (02) 325-340
  • 4 Baratz ME, Des Jardins Jd, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg Am 1996; 21 (02) 183-188
  • 5 Lundy DW, Quisling SG, Lourie GM, Feiner CM, Lins RE. Tilted lateral radiographs in the evaluation of intra-articular distal radius fractures. J Hand Surg Am 1999; 24 (02) 249-256
  • 6 Mekhail AO, Ebraheim NA, McCreath WA, Jackson WT, Yeasting RA. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surg Am 1996; 21 (04) 567-573
  • 7 Soong M, Got C, Katarincic J, Akelman E. Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study. J Hand Surg Am 2008; 33 (10) 1720-1723
  • 8 Kumar D, Breakwell L, Deshmukh SC, Singh BK. Tangential views of the articular surface of the distal radius-aid to open reduction and internal fixation of fractures. Injury 2001; 32 (10) 783-786
  • 9 Boyer MI, Korcek KJ, Gelberman RH, Gilula LA, Ditsios K, Evanoff BA. Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation. J Hand Surg Am 2004; 29 (01) 116-122