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Volar locking plate fixation of distal radius fractures: use of an intra-operative ‘carpal shoot through’ view to identify dorsal compartment and distal radioulnar joint screw penetration

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HAND

Abstract

Introduction

We report our experience using a ‘carpal shoot through’ view of the distal radius to identify dorsal compartment screw penetration intra-operatively when performing volar plating of the distal radius.

Methods

A prospective study of 42 patients (mean age 56 years) with acute distal radius fractures treated with open reduction internal fixation was undertaken. Surgical fixation was performed using a volar locking plate in all patients. After plate application, inclined posteroanterior and lateral radiographs were taken followed by the carpal shoot through view.

Results

In six cases (14 %), the carpal shoot through view revealed dorsal screw protrusion, which was not detectable on standard PA and lateral views. In one case, a screw had penetrated the distal radioulnar joint (DRUJ), which was only apparent on the shoot through view. The overall screw exchange rate was 17 %.

Conclusions

Using the hand and carpus to minimise the contrast in X-ray penetration, the dorsal cortex of the distal radius may be imaged intra-operatively and dorsal compartment screw penetration detected in cases with significant multifragmentation when screw measurement is difficult. This view potentially reduces the risk of post-operative pain and extensor tendon injury and also provides excellent visualisation of the DRUJ.

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Conflict of Interest

Daniel Marsland declares that he has no conflict of interest.

Chris M. Hobbs declares that he has no conflict of interest.

Philip S. Sauvé declares that he has no conflict of interest.

Statement of Human and Animal Rights

No experiments were undertaken on humans or animals for this study. We describe a prospective study assessing an established surgical technique at our institution, and therefore ethical approval was not necessary.

Statement of Informed Consent

No identifying information about patients is included in the current study, and therefore informed consent was not required.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK

    Daniel Marsland, Chris M. Hobbs & Philip S. Sauvé

  2. Orthopaedic Office Suite, Clinical Administration, F Level, Queen Alexandra Hospital, Cosham, Portsmouth, Hants, PO6 3LY, UK

    Daniel Marsland

Authors
  1. Daniel Marsland
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  2. Chris M. Hobbs
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  3. Philip S. Sauvé
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Correspondence to Daniel Marsland.

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Marsland, D., Hobbs, C.M. & Sauvé, P.S. Volar locking plate fixation of distal radius fractures: use of an intra-operative ‘carpal shoot through’ view to identify dorsal compartment and distal radioulnar joint screw penetration. HAND 9, 516–521 (2014). https://doi.org/10.1007/s11552-014-9607-0

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  • DOI: https://doi.org/10.1007/s11552-014-9607-0

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