Detections of Screw Penetration during Volar Plating for Distal Radius Fractures

Abstract

Background We evaluated the detection for screw penetration on the dorsal cortex of the radius in serial oblique, dorsal tangential, and radial groove radiographic views in volar plating fixation.

Materials and Methods Eight screw positions were set in each of the four cadaveric radii. Screw 1 was placed in the styloid subregion, whereas screws 2 and 3 were placed just proximal to the styloid and were defined for the radial region of the radius. Screws 4 (distal to the extensor pollicis longus [EPL] groove), 5 (the distal half of the groove), and 6 (the proximal half of the groove) were placed in the central region of the radius. Screws 7 (just medial to the groove) and 8 (sigmoid notch subregion) were positioned in the ulnar region of the radius. The screws were overlengthened by 1 and 2 mm and were evaluated in three radiographic views.

Results Penetrations in the radial region were fully visible in supinated oblique views with 1- and 2-mm overlengthened screws. The penetration of screw 4 was clearly observable over a considerable range of views. However, the 1-mm penetration of screw 5 was not detectable at any angle of projection. Detection of the ulnar region screw was the most difficult among the three regions with oblique views. In the dorsal tangential view, the 1-mm penetration of screw 4 was not observed in any of the four radii, but the penetration of screw 5 was detectable in all the radii. The screws 2, 3, 5, 7, and 8 were readily detectable. The screw 4 was barely seen in the radial groove view, while the screws 5 and 6 were readily detectable.

Conclusion/Clinical Relevance Appropriate combinations of these well-known radiological views are essential for the overall detection of penetrated screws during plating in distal radius fractures.

Keywords

screw perforation - volar plating - oblique view - dorsal tangential view - radial groove view

Ethical Review Committee Statement

Our Institutional Review Board approved this study (IRB No. CNUH 2014–12–011).

Funding

None.

• References

• 1 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (05) 316-322
• 2 Benson EC, DeCarvalho A, Mikola EA, Veitch JM, Moneim MS. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res 2006; 451: 218-222
• 3 Bianchi S, van Aaken J, Glauser T, Martinoli C, Beaulieu JY, Della Santa D. Screw impingement on the extensor tendons in distal radius fractures treated by volar plating: sonographic appearance. Am J Roentgenol 2008; 191 (05) W199-W203
• 4 Joseph SJ, Harvey JN. The dorsal horizon view: detecting screw protrusion at the distal radius. J Hand Surg Am 2011; 36 (10) 1691-1693
• 5 Ozer K, Wolf JM, Watkins B, Hak DJ. Comparison of 4 fluoroscopic views for dorsal cortex screw penetration after volar plating of the distal radius. J Hand Surg Am 2012; 37 (05) 963-967
• 6 Pichler W, Windisch G, Schaffler G, Rienmüller R, Grechenig W. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur Vol 2009; 34 (05) 598-602
• 7 Riddick AP, Hickey B, White SP. Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. J Hand Surg Eur Vol 2012; 37 (05) 407-411
• 8 Lee SK, Bae KW, Choy WS. Use of the radial groove view intra-operatively to prevent damage to the extensor pollicis longus tendon by protruding screws during volar plating of a distal radial fracture. Bone Joint J 2013; 95-B (10) 1372-1376
• 9 Hattori Y, Doi K, Sakamoto S, Yukata K. Delayed rupture of extensor digitorum communis tendon following volar plating of distal radius fracture. Hand Surg 2008; 13 (03) 183-185
• 10 Ward JP, Kim LT, Rettig ME. Extensor indicis proprius and extensor digitorum communis rupture after volar locked plating of the distal radius--a case report. Bull NYU Hosp Jt Dis 2012; 70 (04) 273-275
• 11 Singh HP, Srinivasan S, Ullah A. Closed rupture of the extensor indicis and extensor digitorum tendons to the index finger after locking plate fixation of a fracture of the distal radius. J Hand Surg Eur Vol 2013; 38 (01) 86-87
• 12 Haug LC, Glodny B, Deml C, Lutz M, Attal R. A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view. Bone Joint J 2013; 95-B [phone]
• 13 Liou T-S, Wang M-JJ. Ranking fuzzy numbers with integral value. J Statistical Field 1992; 50 (03) 247-255
• 14 Brunner A, Siebert C, Stieger C, Kastius A, Link BC, Babst R. The dorsal tangential X-ray view to determine dorsal screw penetration during volar plating of distal radius fractures. J Hand Surg Am 2015; 40 (01) 27-33
• 15 Clement H, Pichler W, Nelson D, Hausleitner L, Tesch NP, Grechenig W. Morphometric analysis of Lister's tubercle and its consequences on volar plate fixation of distal radius fractures. J Hand Surg Am 2008; 33 (10) 1716-1719
• 16 Knight D, Hajducka C, Will E, McQueen M. Locked volar plating for unstable distal radial fractures: clinical and radiological outcomes. Injury 2010; 41 (02) 184-189
• 17 Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN. Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (NY) 2007; 2 (03) 144-150