Minke Bergsma1, Job N Doornberg2, Robin Duit3, Aimane Saarig4, David Worsley5, Ruurd Jaarsma6. 1. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia; Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia; University of Amsterdam, 1012 XW, Amsterdam, The Netherlands. Electronic address: minkebergsma@hotmail.com. 2. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia; Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia; University of Amsterdam, 1012 XW, Amsterdam, The Netherlands. Electronic address: doornberg@traumaplatform.org. 3. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia. Electronic address: robinduit@gmail.com. 4. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia; Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia; University of Amsterdam, 1012 XW, Amsterdam, The Netherlands. Electronic address: a.saarig@amc.uva.nl. 5. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia; Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia. Electronic address: david.worsley@sa.gov.au. 6. Flinders Medical Centre, Flinders Drive, Bedford Park, SA5042, Australia; Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia. Electronic address: ruurd.Jaarsma@sa.gov.au.
Abstract
PURPOSE: The purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients. MATERIALS AND METHODS: 100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative -screw- revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated. RESULTS: Additional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12-26 mm), and these were changed to a mean length of 20 mm (range, 10-22 mm). CONCLUSION: In this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard. LEVEL OF EVIDENCE: .Prognostic I.
PURPOSE: The purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients. MATERIALS AND METHODS: 100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative -screw- revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated. RESULTS: Additional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12-26 mm), and these were changed to a mean length of 20 mm (range, 10-22 mm). CONCLUSION: In this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard. LEVEL OF EVIDENCE: .Prognostic I.
Authors: Jasper Prijs; Bram Schoolmeesters; Denise Eygendaal; Jean-Paul P M de Vries; Paul C Jutte; Job N Doornberg; Ruurd L Jaarsma; Frank F A IJpma Journal: Eur J Trauma Emerg Surg Date: 2021-10-08 Impact factor: 2.374