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.

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 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.

Comparison of 4 Fluoroscopic Views for Dorsal Cortex Screw Penetration After Volar Plating of the Distal Radius

2012 ◽  
Vol 37 (5) ◽  
pp. 963-967 ◽  
Author(s):  
Kagan Ozer ◽  
Jennifer M. Wolf ◽  
Bruce Watkins ◽  
David J. Hak
Keyword(s):  
Distal Radius ◽  
Dorsal Cortex ◽  
Volar Plating ◽  
Screw Penetration

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 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 Sensitivity and Specificity of Skyline and Carpal Shoot-Through Fluoroscopic Views of Volar Plate Fixation of the Distal Radius: A Cadaveric Investigation of Dorsal Cortex Screw Penetration

Hand ◽  
2016 ◽  
Vol 12 (6) ◽  
pp. 551-556 ◽  
Author(s):  
T. Kyle Stoops ◽  
Brandon G. Santoni ◽  
Nicolette M. Clark ◽  
Amy A. Bauer ◽  
Christopher Shoji ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Sensitivity And Specificity ◽  
Distal Radius ◽  
Plate Fixation ◽  
Soft Tissue Injuries ◽  
Volar Plate ◽  
Dorsal Cortex ◽  
Volar Plate Fixation ◽  
Screw Penetration ◽  
Depth Gauge

Background: Volar plate fixation of distal radius fractures can result in soft tissue injuries. Abnormal contour of the dorsal cortex of the distal radius provides difficulties in discerning screw penetration on standard radiographs. The skyline and carpal shoot-through views are additional views to improve dorsal cortex visibility. We report on the sensitivity and specificity of determining screw protrusion with these views. Methods: Seven fresh frozen cadavers were instrumented with a distal radius volar locking plate. Initial screw length was determined by depth gauge measurement. A dorsal dissection of the wrist was performed to detect screw penetration. Protruding screws were documented and replaced with screws of the appropriate length and deemed as baseline. Screws were then sequentially lengthened by 2 and 4 mm. Skyline and carpal shoot-through views were obtained at baseline, 2 mm, and 4 mm. The images were randomized and compiled into an untimed survey asking orthopedic surgeons to determine whether screws were penetrating through the dorsal cortex. Results: Based on depth gauge measurements, 4 out of 44 (9.1%) volar plate locking screws penetrated the dorsal cortex, as confirmed with dorsal dissection. Sensitivities for the skyline and carpal shoot-through views were 75% and 86% ( P ≤ .001), respectively, for 2-mm protrusions, and 76% and 89% ( P ≤ .001), respectively, for 4-mm screw protrusions. Specificities were 85% and 84% for the skyline and shoot-through views, respectively. Conclusions: We believe that the carpal shoot-through view has utility and can be implemented to augment standard intraoperative views, and may decrease the incidence of screw protrusion resulting in soft tissue injuries.

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.

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