Abstract
Background
Extensor tendon irritation and attritional tendon ruptures are well-recognized complications, secondary to dorsal screw penetration following volar plating of the distal radius. Lateral and oblique views of the wrist have limited ability to detect such penetration, particularly at the ulnar side of the Lister's tubercle. In this report, we conducted an intraoperative fluoroscopic study to determine dorsal screw penetration in various positions of the wrist/forearm and compared the standard radiographic views (lateral, supination, and pronation views) with dorsal tangential view of the wrist.
Materials and Method
Standard lateral, oblique (in pronation and supination), and dorsal tangential views were obtained in 27 consecutive patients undergoing fixation a distal radius fractures using a volar plate. The number of penetrating screws in each dorsal compartment (second, third, fourth) was recorded in each view. Dorsal tangential view was obtained using a mini C-arm intraoperatively and sending the beam parallel to the dorsal aspect of the wrist in transverse plane.
Results
Of the 125 distal screws, 8 screws were seen to be penetrating the dorsal cortex in lateral and oblique views, whereas 11 screws were detected in dorsal tangential view.
Conclusion
The screw penetration to the third dorsal compartment was missed in standard views, but visualized in dorsal tangential view. We recommend the use of dorsal tangential view in addition to standard lateral and oblique views during volar plating of the distal radius.
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References
Al-Rashid M, Theivendran K, Craigen MA. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br. 2006;88:1610–2.
Arora R, Lutz M, Hennerbichler A, Krappinger D, et al. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21:316–22.
Benson EC, DeCarvalho A, Mikola EA, et al. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res. 2006;451:218–22.
Boyer MI, Korcek KJ, Gelberman RH, et al. Anatomic, tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation. J Hand Surg Am. 2004;29:116–22.
Failla JM, Koniuch MP, Moed BR. Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases. J Hand Surg Am. 1993;18:648–51.
Jacob J, Clay NR, et al. Re: Pichler et al. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur. 2009;34:598–602. Comment in: J Hand Surg Eur Vol. 2010, 35: 335.
Jenkins NH, Mackie IG. Late rupture of the extensor pollicis longus tendon: the case against attrition. J Hand Surg Br. 1988;13:448–9.
Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system in internal fixation of the distal radius: a brief report. J Hand Surg Am. 1998;23:737–41.
Maschke SD, Evans PJ, Schub D, et al. Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (NY). 2007;2(3):144–50.
Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005;13:159–71.
Nunley JA, Rowan PR. Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius. J Hand Surg Am. 1999;24:1279–80.
Orbay JL, Fernandez DL. Volar fixation of dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27:205–15.
Payne AJ, Harris NJ, Kehoe NJ. Bilateral delayed extensor pollicis longus rupture following bilateral undisplaced distal radial fractures. Orthopedics. 2000;23:163.
Pichler W, Windisch G, Schaffler G, et al. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur. 2009;34:598–602.
Smith DW, Henry MH. The 45° pronated oblique view for volar fixed-angle plating, of distal radius fractures. J Hand Surg. 2004;29:703–6.
Stahl S, Wolff TW. Delayed rupture of the extensor pollicis longus tendon after nonunion of a fracture of the dorsal radial tubercle. J Hand Surg Am. 1988;13:338–41.
Wong-Chung J, Quinlan W. Rupture of extensor pollicis longus following fixation of a distal radius fracture. Injury. 1989;20:375–6.
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This study was accepted as a podium presentation for the American Association for Hand Surgery, Annual Meeting in 2011.
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Ozer, K., Toker, S. Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating. HAND 6, 190–193 (2011). https://doi.org/10.1007/s11552-010-9316-2
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DOI: https://doi.org/10.1007/s11552-010-9316-2