Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation


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Oc Y., Kilinc B. E., Gulcu A., Varol A., Ertugrul R., KARA A.

Journal of Orthopaedic Surgery and Research, vol.13, no.1, 2018 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 13 Issue: 1
  • Publication Date: 2018
  • Doi Number: 10.1186/s13018-018-0774-5
  • Journal Name: Journal of Orthopaedic Surgery and Research
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: Distal radius, Ultrasonic evaluation, Volar plating, Dorsal cortex penetration, Screw penetration
  • Istanbul Medipol University Affiliated: Yes

Abstract

Background: Complications related to extensor tendons have begun to increase with the use of volar plates in the treatment of distal radius fractures. In this study, we aimed to compare four-plane radiography and ultrasonography in the evaluation of dorsal cortex screw penetration following volar plate fixation. Methods: We recruited 47 patients (33 males, 14 females, mean age 37.4 years; range 18-58 years). To evaluate dorsal screw penetration in all patients, we performed radiographs at 45° pronation, 45° supination and obtained dorsal tangential graphs at maximum palmar flexion, and a wrist lateral radiograph. Wrist ultrasonography was performed in all patients. Results: Dorsal screw penetration was detected in 12 of the 47 patients undergoing VLP application. While there was >2 mm screw penetration in seven patients, there was <2 mm screw penetration in five patients. On four-plane radiographs, screw penetration >2 mm was detected in seven patients and screw penetration <2 mm was detected in two patients. On four-plane radiography, dorsal screw penetration was not detected in three out of five patients, who were shown to have <2 mm screw penetration by ultrasonography. In addition to perioperative four-plane radiographs are also required to detect dorsal cortex penetration in patients undergoing VLP due to distal radius fracture. However, the detection of screw penetrations <2 mm is more likely with ultrasonography compared to four-plane radiography. Conclusion: We recommend that dorsal cortex screw penetration should be evaluated with perioperative ultrasonography.