Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius

Yang, Jui-Ming; Wang, Chien-Kuo; Lin, Wei-Wen; Li, Chung‐Yi; Su, Fong-Chin; Jou, I‐Ming; Wu, Po‐Ting

doi:10.1002/jor.25341

Journal Orthopaedic Research

2022

DOI: 10.1002/jor.25341

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Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius

Jui-Ming Yang

Chien-Kuo Wang

Wei-Wen Lin

et al.

Abstract: We compared the accuracy of the fluoroscopic dorsal tangential view (DTV) and an ultrasound (US) examination in detecting dorsal screw penetration during volar distal radius plating. In six fresh cadaveric distal radii, seven periarticular locking screws in two rows for each plate were inserted according to the measured length using a depth gauge and then replaced with another that was 1 and 2 mm longer, respectively. The actual protruded length of each screw was determined using computed tomography (CT) image… Show more

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2024

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Cited by 3 publications

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Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Persitz,

Essa,

Shor

et al. 2024

J Wrist Surg

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Introduction Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and/or into the distal radioulnar joint (DRUJ). Materials and Methods Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method. Results The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view. Conclusion Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required. Level of Evidence: Therapeutic level V.

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Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Persitz,

Essa,

Shor

et al. 2024

J Wrist Surg

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Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate

Laane,

Dijkmans,

Messinger

et al. 2024

Hand (New York, N,Y.)

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Background: This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence. Methods: This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months. Results: The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent. Conclusions: The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.

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Anatomy of Lister’s Tubercle: Implications for Volar Locked Plating of the Distal Radius

Laane,

Raasveld,

de Klerk

et al. 2024

Hand (New York, N,Y.)

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Background: Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister’s tubercle on the dorsal aspect of the radius. Methods: The anatomy and location of Lister’s tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister’s tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female. Results: As measured in cadaveric arms, the mean Lister’s tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister’s tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister’s tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister’s tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister’s tubercle. Conclusions: Knowledge of Lister’s tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures. Level of evidence: IV—Therapeutic.

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Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius

Cited by 3 publications

References 24 publications

Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate

Anatomy of Lister’s Tubercle: Implications for Volar Locked Plating of the Distal Radius

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