Daniel Marsland1, Chris M Hobbs2, Philip S Sauvé2. 1. Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK ; Orthopaedic Office Suite, Clinical Administration, F Level, Queen Alexandra Hospital, Cosham, Portsmouth, Hants PO6 3LY UK. 2. Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK.
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.
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.
Authors: T Kyle Stoops; Brandon G Santoni; Nicolette M Clark; Amy A Bauer; Christopher Shoji; Francisco Schwartz-Fernandes Journal: Hand (N Y) Date: 2016-11-01
Authors: Sebastian A Müller; Lars Adolfsson; Cornelia Baum; Magdalena Müller-Gerbl; Andreas M Müller; Daniel Rikli Journal: JB JS Open Access Date: 2021-05-05