scholarly journals Diaphyseal Screw Prominence in Distal Radius Volar Plating

2020 ◽  
Vol 09 (03) ◽  
pp. 214-218
Author(s):  
Kevin Eng ◽  
Stephen Gil ◽  
Richard Page
Keyword(s):  
Distal Radius ◽  
Tendon Injury ◽  
Dorsal Side ◽  
X Rays ◽  
Volar Plating ◽  
Radius Fractures ◽  
X Ray ◽  
Screw Penetration ◽  
With Screws ◽  
Neutral Angle

Abstract Background Volar plating for distal radius fractures has become common. Screw prominence on the dorsal side from long screws can lead to tendon injury. Methods for detecting screws that penetrate the far cortex involve X-ray or ultrasound. These have focused on the distal row of screws. No studies have addressed screw penetration in the diaphysis. We describe two cases where diaphyseal screws caused symptoms. We then insert screws in the diaphysis of synbones 2 mm longer than measured and determine what angle of pronation or supination was best to detect this on X-ray. Methods Three synbones were plated using Synthes volar plate. The three diaphyseal screws were drilled perpendicular to the plate, and the depth measured. Cortical 2.4-mm screws were inserted, 2 mm longer than measured. The three synbones were then placed in a custom clamp to measure rotation. Lateral X-rays were taken at 0 degree rotation, and 5, 10, and 15 degrees of supination and pronation. The prominence of each screw was measured using the synapse digital ruler. Results For the screws that were placed at a neutral angle (perpendicular to the plate) the maximum visualization of the prominent tips occurred around 0 degree rotation. With screws angled 15 degrees ulna, maximum visualization was between 5 and 10 degrees of pronation. With screws angled 15 degrees radial, maximum visualization was between 5 and 10 degrees of supination. Every 5 degrees of rotation changes the profile of the screw by 0.4 mm. Discussion The diaphysis of the radius becomes approximately trapezoidal distally. Prominent screws that are placed below the “peak” of the trapezoid may appear to be the correct length. Rotating the wrist into pronation or supination to bring the relevant cortex as parallel to the X-ray beam as possible will help to identify if screws are of the correct length. Screws that are prominent in the second compartment may be particularly symptomatic as the tendons here are closely opposed to the bone. We recommend screening for 2 mm diaphyseal screw prominence in neutral, with 10 degrees of pronation and supination.

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

2015 ◽  
Vol 40 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Alexander Brunner ◽  
Christin Siebert ◽  
Claudia Stieger ◽  
Alexander Kastius ◽  
Björn-Christian Link ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
X Ray ◽  
Screw Penetration

scholarly journals Volar Plating: Imaging Modalities for the Detection of Screw Penetration

2019 ◽  
Vol 08 (06) ◽  
pp. 520-530
Author(s):  
Minke Bergsma ◽  
Katharina Denk ◽  
Job N. Doornberg ◽  
Michel P. J. van den Bekerom ◽  
Gino M. M. J. Kerkhoffs ◽  
...  
Keyword(s):  
Distal Radius ◽  
Imaging Modality ◽  
Distal Radius Fractures ◽  
Imaging Modalities ◽  
In Vivo Studies ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Additional Imaging ◽  
Screw Penetration

Abstract Background Volar plating for distal radius fractures exposes the risk of extensor tendon rupture, mechanical problems, and osteoarthritis due to protruding screws. Purposes The purpose of this review was to identify the best intraoperative diagnostic imaging modality to identify dorsal and intra-articular protruding screws in volar plating for distal radius fractures. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for this review. In vitro and in vivo studies that analyzed the reliability, efficacy, and/or accuracy of intraoperatively available imaging modalities for the detection of dorsal or intra-articular screw protrusion after volar plating for distal radius fractures were included. Results Described additional imaging modalities are additional fluoroscopic views (pronated views, dorsal tangential view [DTV], radial groove view [RGV], and carpal shoot through [CST] view), three-dimensional (3D) and rotational fluoroscopies, and ultrasound (US). For detection of dorsal screw penetration, additional fluoroscopic views show better results than conventional views. Based on small (pilot) studies, US seems to be promising. For intra-articular screw placement, 3D or 360 degrees fluoroscopy shows better result than conventional views. Conclusion Based on this systematic review, the authors recommend the use of at least one of the following additional imaging modalities to prevent dorsal protruding screws: CST view, DTV, or RGV. Tilt views are recommended for intra-articular assessment. Of all additional fluoroscopic views, the DTV is most studied and proves to be practical and time efficient, with higher efficacy, accuracy, and reliability compared with conventional views. Level of Evidence The level of evidence is Level III.

scholarly journals Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kunihiro Oka ◽  
Ryoya Shiode ◽  
Yuichi Yoshii ◽  
Hiroyuki Tanaka ◽  
Toru Iwahashi ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Diagnostic Tests ◽  
Styloid Process ◽  
Final Diagnosis ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Radius Fractures ◽  
X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

scholarly journals 3D virtual pre-operative planning may reduce the incidence of dorsal screw penetration in volar plating of intra-articular distal radius fractures

2021 ◽  
Author(s):  
Jasper Prijs ◽  
Bram Schoolmeesters ◽  
Denise Eygendaal ◽  
Jean-Paul P. M. de Vries ◽  
Paul C. Jutte ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Distal Radius ◽  
Three Dimensional ◽  
Imaging Study ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Operative Planning ◽  
Screw Penetration ◽  
Diagnostic Imaging Study

Abstract Purpose To evaluate the effect of three-dimensional virtual pre-operative planning (3DVP) on the incidence of dorsal screw penetration after volar plating of distal radius fractures. Methods A cross-sectional diagnostic imaging study was performed. Twenty out of 50 patients were randomly selected from our index prospective cohort (IPC): a prior study evaluating dorsal tangential views (DTVs) in reducing dorsal screw penetration in internal fixation of intra-articular distal radius fractures using post-operative CT scans to quantify screw protrusion. Pre-operative CTs from this cohort were now used for 3DVP by three experienced orthopaedic trauma surgeons (supplementary video). 3DVP was compared with the corresponding post-operative CT for assessing screw lengths and incidence of dorsal penetration. The Wilcoxon Signed Ranks test was used to compare screw lengths and the Fishers’ exact for incidence of penetration. Results Three surgeons performed 3DVP for 20 distal radius fractures and virtually applied 60 volar plates and 273 screws. Median screw length was shorter in the 3DVP when compared to IPC: 18 mm (range, 12–22) versus 20 mm (range, 14–26) (p < 0.001). The number of penetrating screws was 5% (13/273 screws) in the 3DVP group compared to 11% (10/91 screws) in the IPC (p = 0.047). Corresponding to a reduction in incidence of at least one dorsally penetrating screw in 40% of patients in the IPC group, to 18% in the 3DVP group (p = 0.069). Conclusion Three-Dimensional Virtual Pre-Operative Planning (3DVP) may reduce the incidence of dorsally penetrating screws in patients treated with volar plating for intra-articular distal radius fractures. Level of evidence II, diagnostic imaging study.

scholarly journals Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

2019 ◽  
Vol 08 (06) ◽  
pp. 482-488 ◽  
Author(s):  
Peter Kaiser ◽  
Hannes Gruber ◽  
Fanny Loth ◽  
Gernot Schmidle ◽  
Rohit Arora ◽  
...  
Keyword(s):  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Distal Radius Fractures ◽  
Ultrasound Images ◽  
Flexor Pollicis Longus ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
X Ray ◽  
Flexor Pollicis Longus Tendon

Abstract Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

scholarly journals Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

Injury ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 1810-1815 ◽  
Author(s):  
Minke Bergsma ◽  
Job N. Doornberg ◽  
Robin Duit ◽  
Aimane Saarig ◽  
David Worsley ◽  
...  
Keyword(s):  
Clinical Study ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Prospective Clinical Study ◽  
Volar Plating ◽  
Radius Fractures ◽  
Screw Penetration

scholarly journals New diagnostic and therapeutic possibilities in the treatment of elbow and distal forearm fractures in childhood

2019 ◽  
Author(s):  
Marcell Varga
Keyword(s):  
Intramedullary Nailing ◽  
Distal Radius ◽  
Point Of Care ◽  
Tendon Injury ◽  
X Rays ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Radius Fractures ◽  
Diagnostic Efficacy ◽  
Elbow Fractures

Fractures of the elbow and distal forearm are among the most frequent injuries in children. The spectrum of these injuries is very wide from small contusions without clinical consequences to severely displaced fractures with limb threatening conditions. Primary diagnosis and treatment are often performed by emergency physicians, general practitioners or paediatric surgeons. Indications of unnecessary imaging procedures, under- and over-treatment may occur by less-specialised healthcare personnel. Recognizing certain elbow fractures may be a challenge even for an experienced orthopaedic surgeon due to the special characteristics of childhood. Certain distal forearm and elbow fractures may not be detected by conventional X-rays. The evaluation of severely displaced distal radius fractures and setting up a plan for further treatment may be particularly difficult due to the lack of therapeutic consensus. In recent years, there have been a growing evidence that musculoskeletal ultrasound (MSK-US) can increase the effectiveness of diagnostics and may reduce the number of unnecessary X-rays. Elastic intramedullary nailing of displaced distal radius fractures may have many advantages over traditional percutaneous pinning techniques. Intraoperative musculoskeletal sonography (IoP MSK- US) can further increase the safety of these interventions. The aim was to prove the efficacy of a standardised five-point sonographic screening method of paediatric elbow fractures. US examinations were executed by orthopaedic surgeons in an emergency trauma centre. In a prospective diagnostic study, we investigated a standardised two-point method in the differential diagnosis of paediatric pulled elbow. We developed an objective, point of care imaging method for confirming or ruling out pulled elbow.We aimed to prove the diagnostic effectivity of ultrasound in distal paediatric forearm fractures in a prospective, two-centred study with large number of patients. Examinations were executed by orthopaedic and paediatric surgeons. We also aimed to investigate the diagnostic difference of US in radial fractures with different clinical consequences.We have developed a new operative method for severely displaced distal paediatric radial fractures. In our retrospective study we analysed the results of our technique, which is a stable, physis sparing osteosynthesis with a reduced period of necessary cast immobilization. We introduced a new ultrasound-assisted intraoperative aiming method for the ESIN technique of paediatric radius fractures. The aim of the procedure was to reduce the risk of EPL tendon injury during dorsal entry elastic nailing. This was an observational diagnostic study.Conclusions:US is an effective diagnostic modality in the screening of distal paediatric forearm fractures. US shows the same diagnostic efficacy as X-rays in the exact identification of fractures without displacements and angulated greenstick fractures. Occult radius torus fractures in children may be detected more accurately by US. US can detect unstable and severely displaced distal forearm fractures, but X-rays are mandatory for exact fracture identification and therapeutic plan. Paediatric elbow fractures can be screened by point of care ultrasound Using five standardized US planes increases the diagnostic efficacy of paediatric elbow fractures. Occult paediatric elbow fractures can be detected by US In younger children US may give more accurate information about the exact nature of the fracture than X-rays. The differential diagnosis of pulled elbow can be safely confirmed by a standardized twoplanes US method. Short intramedullary elastic nailing may be an alternative to percutaneous pinning in the treatment of severely displaced paediatric distal metaphyseal fractures. Using short intramedullary nailing in distal paediatric forearm fractures there is a need only a short cast for one or two weeks postoperatively. Intraoperative sonography may reduce the risk of extensor pollicis longus tendon injury during dorsal entry elastic intramedullary nailing of the distal radius.

Sign in / Sign up

Export Citation Format

Share Document