Use of the radial groove view intra-operatively to prevent damage to the extensor pollicis longus tendon by protruding screws during volar plating of a distal radial fracture

Abstract

The aims of this study were to assess the efficacy of a newly designed radiological technique (the radial groove view) for the detection of protrusion of screws in the groove for the extensor pollicis longus tendon (EPL) during plating of distal radial fractures. We also aimed to determine the optimum position of the forearm to obtain this view. We initially analysed the anatomy of the EPL groove by performing three-dimensional CT on 51 normal forearms. The mean horizontal angle of the groove was 17.8° (14° to 23°). We found that the ideal position of the fluoroscopic beam to obtain this view was 20° in the horizontal plane and 5° in the sagittal plane. We then intra-operatively assessed the use of the radial groove view for detecting protrusion of screws in the EPL groove in 93 fractures that were treated by volar plating. A total of 13 protruding screws were detected. They were changed to shorter screws and these patients underwent CT scans of the wrist immediately post-operatively. There remained one screw that was protruding. These findings suggest that the use of the radial groove view intra-operatively is a good method of assessing the possible protrusion of screws into the groove of EPL when plating a fracture of the distal radius.

Detecting dorsal screw penetration following volar plate fixation of the distal radius – A validation study in a saw bone model

“…12 More recently, views that specifically visualise the dorsal cortex have been described including the dorsal skyline, tangential, horizon and Hoya view. 6,9,[13][14][15][16] The carpal shoot through (CST) view is a modification of the skyline view, taken with the wrist in dorsiflexion rather than palmarflexion. In a recent clinical study of 42 patients, the clinical impact of the CST view was significant, resulting in intra-operative screw exchanges in seven (17%) patients.…”

The Effect of Radial Shaft Dorsal Screw Prominence in Volar Locking Plate Fixation of Distal Radius Fractures

“…16 Finally, special fluoroscopic views have been advocated for intraoperative confirmation of safe screw lengths. 7,11 The purpose of our study, however, was to assess the effect of dorsal screw prominence in proximal radial shaft screws through a volar locking plate.…”

Intraoperative sonography may reduce the risk of extensor pollicis longus tendon injury during dorsal entry elastic intramedullary nailing of the radius in children

“…In adult populations direct injury, increased pressure in the third extensor compartment, poor vascularization, chronic mechanical irritation caused by an implant, callus formation or spontaneous idiopathic rupture may be considered as pathogenic factor theoretically. [ 14 – 17 ] Although, there may be other causes, [ 18 , 19 ] since most of the pediatric EPL injuries found in the literature are related to dorsal entry elastic nailing, it seems to be a unique complication of the dorsal approach. [ 20 – 23 ]…”