Diagnosis of dorsal screw penetration after volar plating of a distal radial fracture

2020 ◽  
Vol 102-B (7) ◽  
pp. 874-880
Author(s):  
David W. G. Langerhuizen ◽  
Minke Bergsma ◽  
Caroline A. Selles ◽  
Ruurd L. Jaarsma ◽  
J. Carel Goslings ◽  
...  
Keyword(s):  
Intraoperative Imaging ◽  
Ct Scans ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Dorsal Cortex ◽  
Volar Plating ◽  
Extensor Pollicis Longus ◽  
3D Fluoroscopy ◽  
Fluoroscopic Imaging ◽  
Screw Penetration

Aims The aim of this study was to investigate whether intraoperative 3D fluoroscopic imaging outperforms dorsal tangential views in the detection of dorsal cortex screw penetration after volar plating of an intra-articular distal radial fracture, as identified on postoperative CT imaging. Methods A total of 165 prospectively enrolled patients who underwent volar plating for an intra-articular distal radial fracture were retrospectively evaluated to study three intraoperative imaging protocols: 1) standard 2D fluoroscopic imaging with anteroposterior (AP) and elevated lateral images (n = 55); 2) 2D fluoroscopic imaging with AP, lateral, and dorsal tangential views images (n = 50); and 3) 3D fluoroscopy (n = 60). Multiplanar reconstructions of postoperative CT scans served as the reference standard. Results In order to detect dorsal screw penetration, the sensitivity of dorsal tangential views was 39% with a negative predictive value (NPV) of 91% and an accuracy of 91%; compared with a sensitivity of 25% for 3D fluoroscopy with a NPV of 93% and an accuracy of 93%. On the postoperative CT scans, we found penetrating screws in: 1) 40% of patients in the 2D fluoroscopy group; 2) in 32% of those in the 2D fluoroscopy group with AP, lateral, and dorsal tangential views; and 3) in 25% of patients in the 3D fluoroscopy group. In all three groups, the second compartment was prone to penetration, while the postoperative incidence decreased when more advanced imaging was used. There were no penetrating screws in the third compartment (extensor pollicis longus groove) in the 3D fluoroscopy groups, and one in the dorsal tangential views group. Conclusion Advanced intraoperative imaging helps to identify screws which have penetrated the dorsal compartments of the wrist. However, based on diagnostic performance characteristics, one cannot conclude that 3D fluoroscopy outperforms dorsal tangential views when used for this purpose. Dorsal tangential views are sufficiently accurate to detect dorsal screw penetration, and arguably more efficacious than 3D fluoroscopy. Cite this article: Bone Joint J 2020;102-B(7):874–880.

scholarly journals Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study

2016 ◽  
Vol 98 (2) ◽  
pp. 138-142 ◽  
Author(s):  
D Williams ◽  
J Singh ◽  
N Heidari ◽  
M Ahmad ◽  
A Noorani ◽  
...  
Keyword(s):  
Distal Radius ◽  
Intraoperative Imaging ◽  
Accurate Method ◽  
Cadaveric Study ◽  
Dorsal Cortex ◽  
Volar Plating ◽  
Specificity And Sensitivity ◽  
Soft Tissue Impingement ◽  
Screw Penetration ◽  
Aids Diagnosis

Introduction Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal screws continues to be a problem in volar plating of the distal radius. Ultrasound is a well recognised, readily available, diagnostic tool used to assess soft-tissue impingement by orthopaedic hardware. In this cadaveric study, we wished to ascertain the sensitivity and specificity of ultrasound for identification of protrusion of dorsal screws after volar plating of the distal radius. Methods Four adult, unpaired phenol-embalmed cadaveric distal radii were used. A VariAx™ Distal Radius Volar Locking Plate system (Stryker, Kalamazoo, MI, USA) was employed for instrumented fixation. A portable SIUI CTS 900 ultrasound machine (Providian Medical, Eastlake, OH, USA) was used to image the dorsal cortex to ascertain screw penetration. Results Specificity and sensitivity of ultrasound for detection of screw protrusion through the dorsal cortex was 100%. Conclusions Ultrasound was found to be a safe and accurate method for assessment of dorsal-screw penetration through the dorsal cortex of the radius after volar plating of the distal radius. It also aids diagnosis of associated tendon disorders (eg tenosynovitis) that might cause pain and limit wrist function.

scholarly journals Detections of Screw Penetration during Volar Plating for Distal Radius Fractures

2017 ◽  
Vol 06 (04) ◽  
pp. 340-348 ◽  
Author(s):  
Soo Cha ◽  
Hyun Shin
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Dorsal Cortex ◽  
Volar Plating ◽  
Radius Fractures ◽  
Extensor Pollicis Longus ◽  
Distal Half ◽  
Proximal Half ◽  
Screw Penetration ◽  
Considerable Range

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.

scholarly journals A Case Report of Distal Radial Fracture with Entrapment of the Extensor Pollicis Longus Tendon.

1993 ◽  
Vol 42 (4) ◽  
pp. 1615-1617
Author(s):  
Naotaka Ibi ◽  
Yoshiichi Sasaki ◽  
Ken Arai ◽  
Hiroyuki Yamamoto ◽  
Kazushige Terado ◽  
...  
Keyword(s):  
Case Report ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
Extensor Pollicis Longus Tendon

No effect on functional outcome after repair of pronator quadratus in volar plating of distal radial fractures: a randomized clinical trial

2019 ◽  
Vol 101-B (12) ◽  
pp. 1498-1505 ◽  
Author(s):  
Jesper Sonntag ◽  
Linn Woythal ◽  
Per Rasmussen ◽  
Ulrik Branner ◽  
Per Hølmer ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
Volar Plating ◽  
Pronator Quadratus ◽  
Pronator Quadratus Muscle ◽  
Repair Group

Aims The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating. Patients and Methods A total of 72 patients with a distal radial fracture were included in this randomized clinical trial. They were allocated to have the pronator quadratus muscle repaired or not, after volar locked plating of a distal radial fracture. The patients, the assessor, the primary investigator, and the statistician were blinded to the allocation. Randomization was irreversibly performed using a web application that guaranteed a secure and tamper-free assignment. The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) after 12 months. Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, pronation strength, grip strength, the range of pronation and supination, complications, and the operating time. Results Of the 72 patients, 63 (87.5%) completed follow-up for the primary outcome measure: 31 (86.1%) from the non-repair group and 32 (88.9%) from the repair group. At the 12-month follow-up, the mean difference in PRWE of 5.47 (95% confidence interval (CI) -4.02 to 14.96) between the repair (mean 18.38 (95% CI 10.34 to 26.41)) and non-repair group (mean 12.90 (95% CI 7.55 to 18.25)) was not statistically significant (p = 0.253). There was a statistically significant difference between pronation strength, favouring non-repair. We found no difference in the other secondary outcomes. Conclusion We found that repairing pronator quadratus made no difference to the clinical outcome, 12 months after volar plating of a distal radial fracture. We conclude that there is no functional advantage in repairing this muscle under these circumstances and advise against it. Cite this article: Bone Joint J 2019;101-B:1498–1505

Magnetic resonance imaging investigation of radio-lunate relations: use in assessing distal radial fracture reduction

2016 ◽  
Vol 42 (3) ◽  
pp. 271-274
Author(s):  
G. Medlock ◽  
J. M. Wohlgemut ◽  
I. M. Stevenson ◽  
A. J. Johnstone
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Fracture Reduction ◽  
Distal Radial Fracture ◽  
Diagnostic Study ◽  
Radial Fracture ◽  
Resonance Imaging ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Outer Border

Reformatted magnetic resonance imaging scans of 27 normal wrists were examined in incremental degrees of rotation around the central axis of the radial shaft to 30° in both directions from true lateral. A line was superimposed on the outer border of the radial dorsal cortex and continued distally to the carpal region. Measurements were made from the superior pole of the lunate to this line. This distance did not change significantly with rotation. This allows a quick and accurate way of assessing distal radial fracture reduction from poorly taken lateral radiographs. In addition, the relevant landmarks are not obscured by implants or casts. Level of evidence: III, diagnostic study

scholarly journals Reduced-dose computed tomography to detect dorsal screw protrusion after distal radius volar plating

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1428
Author(s):  
Kevin J. Leffers ◽  
John W. Kosty ◽  
Glenn M. Garcia ◽  
Daniel C Jupiter ◽  
Ronald W. Lindsey ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Correlation Coefficient ◽  
Distal Radius ◽  
Standard Dose ◽  
Dorsal Cortex ◽  
Volar Plating ◽  
Fixed Angle ◽  
Reduced Dose ◽  
Ct Protocol ◽  
Screw Penetration

Background: Tenosynovitis and tendon rupture caused by screw penetration of the dorsal cortex are common complications after fixed-angle volar plating of a distal radius fracture. Detecting screw prominence with plain radiography is difficult due to the topography of the distal radius dorsal cortex. Computed tomography (CT) offers more detailed imaging of the bone topography, but is associated with radiation exposure. The present cadaveric study compared reduced-dose and standard-dose CT protocols in the detection of dorsal screw protrusion after fixed-angle volar plating of distal radius fracture. If found equivalent, a reduced-dose protocol could decrease the total radiation exposure to patients. Methods: Standard size distal radius volar locking plates were placed using a standard Henry approach in 3 matched pairs of cadaver wrists. A total of 3 distal locking screws were placed at 3 different lengths for a total of 3 rounds of CT scans per wrist pair. Each wrist pair was imaged by CT using standard-dose and reduced-dose protocols. Dorsal screw penetration was measured in each imaging protocol by 3 radiologists at two time periods to calculate inter- and intra-observer variability. Variability was calculated using the concordance correlation coefficient (CCC), intra-class correlation coefficient (ICC), and Pearson correlation coefficient (PCC). Bland-Altman plots were used and assessed 95% limits of agreement. Results: Intra- and inter-observer variabilities, either with the reduced-dose or standard-dose protocol, were >0.85. Pairwise CCC, ICC, and PCC were >0.91. In the comparison of reduced dose versus standard dose between radiologists, correlations were always >0.95. Conclusions: Comparison of a reduced-dose CT protocol and a standard-dose CT protocol for the detection of dorsal penetrating screws after fixed-angle volar plating showed >0.95 correlation in this cadaveric model. A reduced-dose CT protocol is equivalent to a standard dose CT protocol for orthopedic imaging and should reduce radiation exposure.

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