title: Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study.
abstract: BACKGROUND
  Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal screws continues to be a problem in volar plating of the distal radius. Ultrasound is a well recognised, readily available, diagnostic tool used to assess soft-tissue impingement by orthopaedic hardware. In this cadaveric study, we wished to ascertain the sensitivity and specificity of ultrasound for identification of protrusion of dorsal screws after volar plating of the distal radius.
  
  
  METHODS
  Four adult, unpaired phenol-embalmed cadaveric distal radii were used. A VariAx™ Distal Radius Volar Locking Plate system (Stryker, Kalamazoo, MI, USA) was employed for instrumented fixation. A portable SIUI CTS 900 ultrasound machine (Providian Medical, Eastlake, OH, USA) was used to image the dorsal cortex to ascertain screw penetration.
  
  
  RESULTS
  Specificity and sensitivity of ultrasound for detection of screw protrusion through the dorsal cortex was 100%.
  
  
  CONCLUSIONS
  Ultrasound was found to be a safe and accurate method for assessment of dorsal-screw penetration through the dorsal cortex of the radius after volar plating of the distal radius. It also aids diagnosis of associated tendon disorders (eg tenosynovitis) that might cause pain and limit wrist function.
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: J
authors.initials: J
authors.lastname: Singh
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: N
authors.initials: N
authors.lastname: Heidari
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: M
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: A
authors.initials: A
authors.lastname: Noorani
authors.affiliation: The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK.
authors.forename: L
authors.initials: L
authors.lastname: Di Mascio
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008954:Models, Biological; D011884:Radius / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography
keywords: Dorsal screws; Radius; Ultrasound; Volar plates
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