title: A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view.
abstract: Penetration of the dorsal screw when treating distal radius fractures with volar locking plates is an avoidable complication that causes lesions of the extensor tendon in between 2% and 6% of patients. We examined axial fluoroscopic views of the distal end of the radius to observe small amounts of dorsal screw penetration, and determined the ideal angle of inclination of the x-ray beam to the forearm when making this radiological view. Six volar locking plates were inserted at the wrists of cadavers. The actual screw length was measured under direct vision through a dorsal approach to the distal radius. Axial radiographs were performed for different angles of inclination of the forearm at the elbow. Comparing axial radiological measurements and real screw length, a statistically significant correlation could be demonstrated at an angle of inclination between 5° and 20°. The ideal angle of inclination required to minimise the risk of implanting over-long screws in a dorsal horizon radiological view is 15°.
authors.affiliation: Medical University Innsbruck, Department of Trauma Surgery and Sports Medicine, Anichstrasse 35, Innsbruck, Austria.
authors.forename: L C
authors.initials: LC
authors.lastname: Haug
authors.forename: B
authors.initials: B
authors.lastname: Glodny
authors.forename: C
authors.initials: C
authors.lastname: Deml
authors.forename: M
authors.initials: M
authors.lastname: Lutz
authors.forename: R
authors.initials: R
authors.lastname: Attal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D053401:Palmar Plate / Q000601:surgery; D011885:Radius Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery; D014963:X-Ray Intensifying Screens
keywords: Distal radius fracture; Dorsal horizon view; Extensor tendon rupture; Intra-operative image intensifier; Screw penetration; Volar locking plates