Abstract
Introduction
Distal radius fractures are the most commonly reported fractures in adults. Treatment has changed in recent years to open reduction and palmar plate fixation. Penetration of the dorsal screw, however, is a well-known complication. Intraoperative anteroposterior and lateral radiographs lack the exact assessment of dorsal screw length and intraoperative measurement is therefore very likely to be inaccurate in a comminuted dorsal radial cortex. Secondary extensor tendon ruptures are reported in up to 6% following palmar plate fixation of distal radius fracture.
Materials and methods
A prospective randomized trial was performed to assess the value of the dorsal horizon view. The hypothesis was that the traditional anteroposterior and lateral fluoroscopic views aided by an axial view of the dorsal part of the radius, named dorsal horizon view, could prevent dorsal screw penetration. A total of 40 patients, 6 male and 34 female, were included in the study. Standardized anteroposterior and lateral radiographs were performed intraoperatively in 18 patients (standard group = control group). In 22 patients, intraoperative axial fluoroscopic views (dorsal horizon view) were added to anteroposterior and lateral images (horizon group). Numbers of intraoperative screw changes due to the two different radiological examinations were analyzed as well as exact postoperative CT guided measurement of screw length.
Results
The total numbers of intraoperative screw changes were significantly higher in the horizon group. Forty-two screws were changed in 15 patients in the horizon group while only 8 screws were changed in 3 patients in the standard group. Postoperative computed tomography scans showed significantly lower total numbers of perforating screws in the horizon group with 11 screws in 22 patients compared to 20 screws in 18 patients in the standard group (p = 0.02).
Conclusions
Based on the results of this study, the dorsal horizon view improves the assessment of the correct screw length and should routinely be used in palmar plate osteosynthesis of distal radius fractures. Since screw protrusion cannot be absolutely ruled out using the dorsal horizon view, monocortical drilling or screw downsizing is still mandatory.
Trial registration
This clinical trial was not registered because it was a clinical examination without any experimental techniques.
Level of evidence
2.
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Data availability
The data that support the findings of this study are available from the corresponding author, Markus Lill, upon reasonable request.
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Acknowledgements
The authors thank Dr. Georg Zimmermann from PMU Salzburg, for his support in statistical analyses of the data.
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ML: planned the study, did the main patient recruitment and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. GW and CW: contributed in writing the manuscript. TS: contributed in planning the study and patient recruiting. PS: contributed in patient recruiting and writing. CD: contributed in planning and writing the study.
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The study protocol was reviewed and approved by the ethical board of the federal state of Salzburg on the 9.7.2016.
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Lill, M., Schauer, T., Schultes, P. et al. Avoiding screw overlength using dorsal horizon view in palmar plate osteosynthesis of distal radius fractures: a prospective randomized trial. Arch Orthop Trauma Surg 144, 197–204 (2024). https://doi.org/10.1007/s00402-023-05046-y
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DOI: https://doi.org/10.1007/s00402-023-05046-y