Screw prominences related to palmar locking plating of distal radius

Abstract

Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. Of the total 230 locking screws, 59 protruded from the dorsal cortical surface by 0.5 mm or more (range 0.5-6.1 mm). The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.

Volar Plate Fixation for the Treatment of Distal Radius Fractures

“…15 Standard AP and lateral radiographs are usually taken with the x-ray beam perpendicular to the forearm and, hence, may not accurately represent the articular anatomy of the fracture fixation. Because imprecise depth measurement and misinterpretation of the fluoroscopic images can easily lead to penetration of the dorsal cortex, 16 proper positioning must be confirmed using intraoperative radiographic imaging. Recently, additional views to better visualize the articular surface have been proposed 17 : In particular, orienting the forearm in such a manner to produce an image parallel to the radiocarpal joint on both AP (11-degree elevation) and lateral (23-degree elevation) projections have been suggested.…”

Fractures of the Distal Radius and Distal Radioulnar Joint

“…The curved dorsal surface of the distal radius must be taken into account when assessing appropriate screw length on a lateral radiograph. Twenty-fi ve percent of screws placed in a series of 46 volar plates were reported to penetrate the dorsal cortex by up to 6 mm in one study [ 64 ]. Direct measurement of the desired screw length with a depth gauge is a much safer method of selecting screw length, although use of the 'skyline' view during surgery is an accurate way to help avoid this problem [ 65 ].…”

Screw-Bone Implant Loosening: Complication, Cause and Assessment

“…Vernet et al [48] have reported that by the use of ultrasound the rate of detecting long epiphyseal screw was 43.33%. Sugun et al [50] stated the use of ultrasound has detected 59 screws that were protruding with 0.5mm or more from the dorsal cortex of distal radius from the 230 locking screw that were located at the distal rows of the locking plate. Gurbuz et al [51] studies have discover that the accuracy to detect screw penetration for 1mm was 87% in ultrasonography.…”