Prevention of screw penetration of the dorsal cortex in volar plating of distal end radius fracture by using dorsal tangential view
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242670Keywords:
Distal end radius fracture, Volar plating, DTV, Screw penetrationAbstract
Background: The dorsal cortex penetration by a screw can leads to irritation and attritional extensor tendon injury in volar plating of distal end radius fracture. Our method in this study was to use dorsal tangential view (DTV) intraoperatively to detect screw protrusions in the dorsal cortex and replace these screws with screws of appropriate size.
Methods: We have enrolled 60 patients from in patient department of orthopaedics in a rural tertiary care institute (Indian Institute of Medical Science and Research Warudi, Ta. Badnapur, Dist. Jalna, Maharashtra) having distal end radius fracture above 18 years of age planned for volar plating. DTV other than standard PA, lateral view was taken to evaluate the dorsal cortex penetration.
Results: Seven patients required AP and lateral view while 14 patients needed DTV with 80% power (α=0.05, β=0.2).
Conclusions: Our study concluded that additional DTV apart from standard AP and lateral view will detect the dorsal penetration of screws and can be changed intraoperatively. Thus, DTV is advised to minimise the iatrogenic extensor tendon injury by dorsal screw penetration which might be missed in lateral view.
References
Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.
Drobetz H, Bryant AL, Pokorny T, Ralf S, Martin L, Jesse BJ, et al. Volar fixed angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction–a biomechanic study in a cadaveric model. J Hand Surg Am. 2006;31(4):615-22.
Figl M, Weninger P, Liska M, Marcus H, Martin L. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg. 2009;129(5):661-9.
Figl M, Weninger P, Jurkowitsch J, Marcus H, Josef S, Martin L. Unstable distal radius fractures in the elderly patient: volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma. 2010;68(4):992-8.
Rozental TD, Blazar PE, Franko OI, Aron TC, Brandon EE, Charles SD. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(8):1837-46.
Stevenson I, Carnegie CA, Christie EM, Kumar K, Johnstone AJ. Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy. J Trauma 2009;67(3):612-6.
Weninger P, Schueller M, Drobetz H, Michael J, Heinz R, Elmar T. Influence of an additional locking screw on fracture reduction after volar fixed-angle plating-introduction of the “protection screw” in an extra-articular distal radius fracture model. J Trauma. 2009;67(4):746-51.
Weninger P, Dall’Ara E, Leixnering M, Christoph P, Harald H, Herwig D, et al. Volar fixed-angle plating of extra-articular distal radius fractures: a biomechanical analysis comparing threaded screws and smooth pegs. J Trauma. 2010;69(5):E46-55.
Sokol SC, Amanatullah DF, Curtiss S, Szabo RM. Biomechanical properties of volar hybrid and locked plate fixation in distal radius fractures. J Hand Surg Am. 2011;36(4):591-7.
Lafontain M, Hardy D, Delince P. Stability assessment of distal radius fracture. Injury. 1989;20(4):208-10.
Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91(8):1868-73.
Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29(1):96-102.
Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31(3):359-65.
Mignemi ME, Byram IR, Wolfe CC, Kang-Hsien F, Elizabeth AK, John JB, et al. Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am. 2013;38(1):40-8.
Knirk JL, 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.
Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 1992;184(1):15-24.
Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;(206):202-10.
Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987;(220):241-52.
Al-Rashid M, Theivendran K, Craigen MA. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br. 2006;88(12):1610-2.
Arora R, Lutz M, Hennerbichler A, Krappinger D, Dietmar K, David E, Markus G. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21(5):316-22.
Benson EC, DeCarvalho A, Mikola EA, John MV, Moheb SM. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res. 2006;451:218-22.
Failla JM, Koniuch MP, Moed BR. Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases. J Hand Surg Am. 1993;18(4):648-51.
Jenkins NH, Mackie IG. Late rupture of the extensor pollicis longus tendon: the case against attrition. J Hand Surg Br. 1988;13:448-9.
Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system in internal fixation of the distal radius: a brief report. J Hand Surg Am. 1998;23:737-41.
Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005;13(3):159-71.
Hill BW, Shakir I, Cannada LK. Dorsal screw penetration with the use of volar plating of distal radius fractures: how can you best detect? J Orthop Trauma. 2015;29(10):e408-13.
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(5):963-7.
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(1):27-33.
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(3):183-5.
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 (N Y). 2007;2(3):144-50.
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 Jt J. 2013;95-b (8):1101-5.
Dolce D, Goodwin D, Ludwig M, Edwards S. Intraoperative evaluation of dorsal screw prominence after poly axial volar plate fixation of distal radius fractures utilizing the Hoya view: a cadaveric study. Hand (N Y). 2014;9 (4):511-5.
Haug LC, Deml C, Blauth M, Arora R. Dorsal screw penetration following implant removal after volar locked plating of distal radius fracture. Arch Orthop Trauma Surg. 2011;131(9):1279-82.
Candela V, Di Lucia P, Carnevali C, Milanese A, Spagnoli A, Villani C, et al. Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area. J Orthop Traumatol. 2022;23(1):43.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691-7.
