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Systematic use of short unicortical epiphyseal locking screws versus full-length unicortical locking screws in distal radius fracture volar plating: A prospective and comparative study

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Abstract

Purpose

Volar locking plates, used in distal radius fracture (DRF), present a risk of injuring extensor tendons with screws penetrating the dorsal cortex of the radius. Actually, even when aiming to use maximum-length unicortical locking screws, some still could be bicortical. We hypothesize the use of only short unicortical screws would allow a proper stabilization of the radial epiphysis without the risk of dorsal cortex penetration.

Materials and methods

A prospective monocentric non-randomized study was conducted. Patients with DRF (excepted for partial dorsal joint fractures) were treated in group A with short locking epiphyseal screws (16 mm for females, 18 mm for males) and in group B with full-length unicortical locking screws. Ultrasound was done 3 months postoperatively to evaluate the number and length of prominent dorsal screws. X-rays were performed after 6 weeks to assess stability according to volar tilt and radial inclination variations.

Results

There were 37 patients in group A and 39 in group B with 148 and 156 epiphyseal screws, respectively. In group A, there were 0% of dorsal penetrating screws against 6.5% (10 screws from 8 patients) in group B (p < 0.05). There was no significant difference for the stability between the groups: mean volar tilt variation ( − 0.6° vs. − 0.7°) and mean radial inclination variation ( − 0.4° vs. − 0.4°).

Conclusion

For a same stability with volar locking plates for DRF, short epiphyseal locking screws should be preferred to full-length unicortical screws in order to prevent extensor tendon injuries. Based on 75% of distal radial average anteroposterior width for each sex, screw lengths of 16 mm for females and 18 mm for males seem to be the length to use.

Level of Evidence 2

Prospective, Comparisons made, non-randomized.

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Acknowledgements

Many thanks to the Pr Marc Soubeyrand who helped design this study. Many thanks to Ana Roda, translator from Canada, and Grace Batley, from New Zealand, for revising this manuscript.

Funding

No funds were received in support of this study.

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Authors and Affiliations

  1. Orthopedics and Hand Surgery Department, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, Paris, 75012, France

    M. Artuso, M. Protais, O. Herisson, A. Cambon-Binder & A. Sautet

  2. Radiology Department, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, Paris, 75012, France

    A. Miquel

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  1. M. Artuso
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Contributions

MA was involved in conceptualization, methodology, supervision, validation, investigation, data curation, writing (original draft/review and editing) and project administration. MP and OH were involved in conceptualization, methodology, supervision, validation, investigation, data curation, writing (review and editing) and project administration. AM was involved in validation, investigation, data curation, writing (review and editing) and project administration. ACB and AS were involved in conceptualization, methodology, supervision, validation, writing (review and editing) and project administration.

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Correspondence to M. Artuso.

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The authors confirm that the study was approved by the institutional board of their establishment (Assistance-Publique Hôpitaux de Paris) and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Artuso, M., Protais, M., Herisson, O. et al. Systematic use of short unicortical epiphyseal locking screws versus full-length unicortical locking screws in distal radius fracture volar plating: A prospective and comparative study. Eur J Orthop Surg Traumatol 32, 11–18 (2022). https://doi.org/10.1007/s00590-021-02899-0

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  • DOI: https://doi.org/10.1007/s00590-021-02899-0

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