Use of Computed Tomography in Determining the Occurrence of Dorsal and Intra-articular Screw Penetration in Volar Locking Plate Osteosynthesis of Distal Radius Fracture

Diong, Teik Wei; Haflah, Nor Hazla Mohamed; Kassim, Abdul Yazid Mohd; Habshi, Sharifah Majedah Idrus Al; Shukur, M H

doi:10.1142/s2424835518500030

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…However, for dorsal intraarticular fractures, reducing screw length may lead to gap formation or intraarticular steps due to insufficient engagement of the dorsal cortex 3,23 . Interestingly, dorsal protruded screws are not always related to extensor tendon rupture 21,24 . Sugun et al 12 found that screw protrusion of more than 1.5 mm in the third or fourth dorsal compartment is likely to cause problems, including ultrasonographic tenosynovitis and ultrasonographical partial or total tendon rupture with clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, distal locking screws for volar plating in distal radius fracture that are intentionally 2-4 mm shorter than the measured length have been suggested due to the high incidence of dorsal screw penetration detected by CT. 18,21 A biomechanical study suggested that unicortical locking screws should be at least 75% of the measured length of a bicortical screw that provides stiffness similar to that of bicortical fixation in extraarticular distal radius fractures. 22 However, for dorsal intraarticular fractures, reducing screw length may lead to gap formation or intraarticular steps due to insufficient engagement of the dorsal cortex.…”

Section: Discussionmentioning

confidence: 99%

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

Yang

Wang

Lin

et al. 2022

Journal Orthopaedic Research

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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) images. The accuracy of US and DTV measurements was determined using the intraclass correlation coefficient (ICC), as both measurements were compared with CT measurements. The ICC of US and DTV was 0.96 and 0.75, respectively, for all screws. After excluding the data for proximalrow screws, the ICC of US remained unchanged at 0.96, and that of DTV improved to 0.86. The ICC of US was significantly higher than that of DTV (p < 0.01). US had a 100% detection rate for screw protrusion of more than 1.0 mm. US examination showed excellent consistency with CT measurements and its accuracy was not affected by screw location. US might thus be a practical tool for detecting dorsal cortex screw penetration during volar distal radius plating.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yang

Wang

Lin

et al. 2022

Journal Orthopaedic Research

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“…The accuracy of screw length has been reported in several studies. In a retrospective study evaluating screw length after repair of distal radial fractures in humans using postoperative radiographs and CT scans, all screws appeared appropriately sized on radiographs but, when analyzed using CT scans, 63% of screws were excessively long and 17% of those were intraarticular 14 . In an ex vivo study of human phalanges, screws were considered optimal in length in only 49.2% of instances.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of depth gauge accuracy in a canine tibial plateau leveling osteotomy model

McChesney¹,

Langenbach²,

Kruger³

et al. 2021

Veterinary Surgery

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Objective To evaluate the accuracy of six depth gauges used in three tibial plateau leveling osteotomy (TPLO) plate holes. Study design Ex vivo experimental study. Animals and sample population Cadaveric canine limbs (n = 10), one 25‐mm‐thick wood board, and one 33.8‐mm‐diameter polyvinyl chloride (PVC) pipe. Methods A TPLO was performed on 10 canine cadaveric pelvic limbs. Three 3.5‐mm plate holes were filled with screws. The remaining three plate holes: a compression hole, a combination compression‐locking hole, and a stacked combination compression‐locking hole were measured by three observers using six commercial depth gauges and using a micrometer as gold standard. The process was repeated on one wood board and one PVC pipe. Results Bone measurements collected using two depth gauges with base diameter < 5 mm were smaller than measurements collected using the four depth gauges with base diameter > 5.5 mm (p ranging from < .001 to .038). Mean depth gauge measurements were smaller than micrometer measurements by 2.20 mm for the compression hole, 0.82 mm for the combination hole, and 3.57 mm for the stacked combination hole. Measurement differences among depth gauges were also present for wood board and PVC pipe measurements. Bone measurement variability between depth gauges was less for the combination and compression holes than for the stacked combination hole. Conclusion Depth gauges lacked accuracy. Measurements differed among gauges and measurement variability varied based on plate hole geometry. Clinical relevance Depth gauge measurement accuracy varies based on measuring devices and on 3.5‐mm plate hole geometry.

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“…Lee et al 22 reported that distal screw insertion close to the articular surface and dorsal rim may be effective in maintaining anatomical reduction; the authors advocated double-tiered subchondral support fixation. Diong et al 23 reported that CT revealed a high incidence of dorsal screw penetration that was not evident on plain radiography, but reported no tendon rupture. They recommended unicortical screw insertion near the cortex, while describing that bicortical fixation may be desirable in osteoporotic patients with displaced dorsal fragments.…”

Section: Discussionmentioning

confidence: 99%

Volar Locking Plate Fixation for Distal Radius Fractures by Intraoperative Computed Tomographic–Guided Navigation

Kawabata

Sogabe

Morimoto

et al. 2020

Journal of Hand Surgery Global Online

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Purpose: Unstable distal radius intra-articular fractures require restoration of alignment. Exact fixation of intra-articular fragments is ideal. Here, we employed intraoperative computed tomography (CT) navigation to insert screws accurately in the intra-articular dorsal fragments during treatment with a volar locking plate for distal radius intra-articular fractures. The main purposes of this study were to evaluate the accuracy of this procedure and the postoperative stability of the articular fragments through CT findings, as well as to assess clinical outcomes. Methods: This study included 26 patients with distal radius fractures, who were treated with a volar locking plate using intraoperative CT navigation with a minimum follow-up of 12 months. Mean patient age was 63 years and mean follow-up was 16 months. We examined the position of the inserted distal screws and articular displacement on preoperative, intraoperative, and postebone union CT images. The 3 distal ulnar screw positions that influence the stability of the dorsoulnar articular fragment were evaluated. The Mayo wrist score and Disabilities of the Arm, Shoulder, and Hand score were also clinically evaluated. Results: Computed tomography evaluation revealed that the distal locking screws were appropriately inserted at the subchondral position, with sufficient length to stabilize the dorsal fragments, and reduction and stability of the articular fragment were acceptable. At the final follow-up, mean Mayo wrist score was 90.8 and mean Disabilities of the Arm, Shoulder, and Hand score was 9.6. Conclusions: Intraoperative CT navigation was successfully used for volar locking plate fixation of intraarticular distal radius fractures. Computed tomography evaluation revealed that the screws were precisely inserted for articular fragments and bone union was achieved, maintaining good intra-articular alignment. The findings demonstrate the accuracy of volar locking plate fixation assisted by intraoperative CT navigation and the good clinical outcomes of this procedure. Type of study/level of evidence: Therapeutic IV.

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Use of Computed Tomography in Determining the Occurrence of Dorsal and Intra-articular Screw Penetration in Volar Locking Plate Osteosynthesis of Distal Radius Fracture

Abstract: This study demonstrated a high incidence of dorsal and intra-articular screw penetration detected by CT scan which was not apparent in plain radiograph. We recommend that surgeons adhere to the principle of only near cortex fixation and downsizing the locking screw length by 2 mm.

Cited by 12 publications

References 30 publications

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

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

Evaluation of depth gauge accuracy in a canine tibial plateau leveling osteotomy model

Volar Locking Plate Fixation for Distal Radius Fractures by Intraoperative Computed Tomographic–Guided Navigation

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