Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 10/2017

01-10-2017 | Trauma Surgery

Comparison of lateral and skyline fluoroscopic views for detection of prominent screws in distal radius fractures plating: results of an ultrasonographic study

Authors: Olivier Herisson, Caroline Delaroche, Sandrine Maillot-Roy, Alain Sautet, Levon Doursounian, Adeline Cambon-Binder

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2017

Login to get access

Abstract

Introduction

Extensor tendon rupture is a recognized complication of volar plate fixation of distal radius fractures due to screws protruding past the dorsal cortex. The aim of this study was to compare the Skyline view with traditional lateral fluoroscopic views using ultrasonography as a reference standard in the postoperative assessment.

Materials and methods

A monocentric prospective study was conducted to identify screws penetrating the dorsal cortex after volar plating of distal radius fractures.

Patients and intervention

Intraoperative anteroposterior (AP) and lateral views were used for group A (28 patients). AP, lateral and skyline fluoroscopic views were used for Group B (40 patients). Prominent screws were changed. Main outcome measurements: Ultrasound was done 6 months postoperatively to evaluate the number and length of prominent dorsal screws and any signs of extensor tenosynovitis.

Results

The number of prominent dorsal screws exceeding 1 mm was 14 in group A (14.9%), and 16 screws (11.8%) in group B (p = 0.487). Average length of prominent dorsal screw was 1.9 mm (range 1–2.1 mm) for group A and 2.4 mm (range 1.1–4.8 mm) for group B (p = 0.534). The number of patients with extensor tenosynovitis was 11 for group A and 12 for group B (p = 0.66).

Conclusions

The Skyline view does not provide sensitive and reliable detection of the dorsal screw penetration. Intraoperative ultrasound might be a better tool to detect screw prominence.

Level of evidence

III, case–control study.
Literature
1.
go back to reference Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 88(12):2687–2694PubMed Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 88(12):2687–2694PubMed
2.
go back to reference Nana AD, Joshi A, Lichtman DM (2005) Plating of the distal radius. J Am Acad Orthop Surg 13(3):159–171CrossRefPubMed Nana AD, Joshi A, Lichtman DM (2005) Plating of the distal radius. J Am Acad Orthop Surg 13(3):159–171CrossRefPubMed
3.
go back to reference Willis AA, Kutsumi K, Zobitz ME, Cooney WP (2006) Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 88(11):2411–2417PubMed Willis AA, Kutsumi K, Zobitz ME, Cooney WP (2006) Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 88(11):2411–2417PubMed
4.
go back to reference Cooper EO, Segalman KA, Parks BG, Sharma KM, Nguyen A (2007) Biomechanical stability of a volar locking-screw plate versus fragment-specific fixation in a distal radius fracture model. Am J Orthop Belle Mead NJ. 36(4):E46–E49PubMed Cooper EO, Segalman KA, Parks BG, Sharma KM, Nguyen A (2007) Biomechanical stability of a volar locking-screw plate versus fragment-specific fixation in a distal radius fracture model. Am J Orthop Belle Mead NJ. 36(4):E46–E49PubMed
5.
go back to reference Koshimune M, Kamano M, Takamatsu K, Ohashi H (2005) A randomized comparison of locking and non-locking palmar plating for unstable Colles’ fractures in the elderly. J Hand Surg Edinb Scotl. 30(5):499–503CrossRef Koshimune M, Kamano M, Takamatsu K, Ohashi H (2005) A randomized comparison of locking and non-locking palmar plating for unstable Colles’ fractures in the elderly. J Hand Surg Edinb Scotl. 30(5):499–503CrossRef
6.
go back to reference Downing ND, Karantana A (2008) A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br 90(10):1271–1275CrossRefPubMed Downing ND, Karantana A (2008) A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br 90(10):1271–1275CrossRefPubMed
7.
go back to reference Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21(5):316–322CrossRefPubMed Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21(5):316–322CrossRefPubMed
8.
go back to reference Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 93(23):2146–2153CrossRefPubMed Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 93(23):2146–2153CrossRefPubMed
9.
go back to reference Rozental TD, Blazar PE (2006) Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg. 31(3):359–365CrossRef Rozental TD, Blazar PE (2006) Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg. 31(3):359–365CrossRef
10.
go back to reference Johnson NA, Cutler L, Dias JJ, Ullah AS, Wildin CJ, Bhowal B (2014) Complications after volar locking plate fixation of distal radius fractures. Injury 45(3):528–533CrossRefPubMed Johnson NA, Cutler L, Dias JJ, Ullah AS, Wildin CJ, Bhowal B (2014) Complications after volar locking plate fixation of distal radius fractures. Injury 45(3):528–533CrossRefPubMed
11.
go back to reference McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg. 26(5):916–922CrossRef McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg. 26(5):916–922CrossRef
12.
go back to reference Al-Rashid M, Theivendran K, Craigen MAC (2006) Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br 88(12):1610–1612CrossRefPubMed Al-Rashid M, Theivendran K, Craigen MAC (2006) Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br 88(12):1610–1612CrossRefPubMed
13.
go back to reference White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD (2012) Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg. 37(10):2035–2040CrossRef White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD (2012) Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg. 37(10):2035–2040CrossRef
14.
go back to reference Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PRT (2013) External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury 44(4):409–416CrossRefPubMed Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PRT (2013) External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury 44(4):409–416CrossRefPubMed
15.
go back to reference Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz M (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133(8):1155–1162CrossRefPubMed Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz M (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133(8):1155–1162CrossRefPubMed
16.
go back to reference Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F (2013) Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma 27(12):740–745CrossRefPubMed Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F (2013) Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma 27(12):740–745CrossRefPubMed
17.
go back to reference Pichler W, Grechenig W, Clement H, Windisch G, Tesch NP (2009) Perforation of the third extensor compartment by the drill bit during palmar plating of the distal radius. J Hand Surg Eur 34(3):333–335CrossRef Pichler W, Grechenig W, Clement H, Windisch G, Tesch NP (2009) Perforation of the third extensor compartment by the drill bit during palmar plating of the distal radius. J Hand Surg Eur 34(3):333–335CrossRef
18.
go back to reference Jacob J, Clay NR (2010) Re: Pichler et al. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur. 2009, 34:598–602. J Hand Surg Eur 35(4):335–336CrossRef Jacob J, Clay NR (2010) Re: Pichler et al. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur. 2009, 34:598–602. J Hand Surg Eur 35(4):335–336CrossRef
19.
go back to reference Haug LC, Glodny B, Deml C, Lutz M, Attal R (2013) A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view. Bone Jt J. 95(8):1101–1105CrossRef Haug LC, Glodny B, Deml C, Lutz M, Attal R (2013) A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view. Bone Jt J. 95(8):1101–1105CrossRef
20.
go back to reference Riddick AP, Hickey B, White SP (2012) Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. J Hand Surg Eur 37(5):407–411CrossRef Riddick AP, Hickey B, White SP (2012) Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. J Hand Surg Eur 37(5):407–411CrossRef
21.
go back to reference Joseph SJ, Harvey JN (2011) The dorsal horizon view: detecting screw protrusion at the distal radius. J Hand Surg. 36(10):1691–1693CrossRef Joseph SJ, Harvey JN (2011) The dorsal horizon view: detecting screw protrusion at the distal radius. J Hand Surg. 36(10):1691–1693CrossRef
22.
go back to reference Vaiss L, Ichihara S, Hendriks S, Taleb C, Liverneaux P, Facca S (2014) The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures. J Wrist Surg. 3(4):245–249CrossRefPubMedPubMedCentral Vaiss L, Ichihara S, Hendriks S, Taleb C, Liverneaux P, Facca S (2014) The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures. J Wrist Surg. 3(4):245–249CrossRefPubMedPubMedCentral
23.
go back to reference Ozer K, Toker S (2011) Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating. Hand N Y N. 6(2):190–193CrossRef Ozer K, Toker S (2011) Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating. Hand N Y N. 6(2):190–193CrossRef
24.
go back to reference Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) Manual of internal fixation: techniques recommended by the AO-ASIF group, 3rd edn. Springer, Berlin, Heidelberg, p 118. ISBN 978-3-662-02695-3 Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) Manual of internal fixation: techniques recommended by the AO-ASIF group, 3rd edn. Springer, Berlin, Heidelberg, p 118. ISBN 978-3-662-02695-3
25.
go back to reference Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A (2008) Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg. 33(7):1135–1143CrossRef Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A (2008) Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg. 33(7):1135–1143CrossRef
26.
go back to reference Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino M-A et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487PubMed Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino M-A et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487PubMed
27.
go back to reference Williams D, Singh J, Heidari N, Ahmad M, Noorani A, Di Mascio L (2016) Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study. Ann R Coll Surg Engl 98(2):138–142CrossRefPubMedPubMedCentral Williams D, Singh J, Heidari N, Ahmad M, Noorani A, Di Mascio L (2016) Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study. Ann R Coll Surg Engl 98(2):138–142CrossRefPubMedPubMedCentral
28.
go back to reference Thomas AD, Greenberg JA (2009) Use of fluoroscopy in determining screw overshoot in the dorsal distal radius: a cadaveric study. J Hand Surg. 34(2):258–261CrossRef Thomas AD, Greenberg JA (2009) Use of fluoroscopy in determining screw overshoot in the dorsal distal radius: a cadaveric study. J Hand Surg. 34(2):258–261CrossRef
29.
go back to reference Park DH, Goldie BS (2012) Volar plating for distal radius fractures—do not trust the image intensifier when judging distal subchondral screw length. Tech Hand Up Extrem Surg. 16(3):169–172CrossRefPubMed Park DH, Goldie BS (2012) Volar plating for distal radius fractures—do not trust the image intensifier when judging distal subchondral screw length. Tech Hand Up Extrem Surg. 16(3):169–172CrossRefPubMed
30.
go back to reference Pichler W, Windisch G, Schaffler G, Rienmüller R, Grechenig W (2009) Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur 34(5):598–602CrossRef Pichler W, Windisch G, Schaffler G, Rienmüller R, Grechenig W (2009) Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur 34(5):598–602CrossRef
31.
go back to reference Clement H, Pichler W, Nelson D, Hausleitner L, Tesch NP, Grechenig W (2008) Morphometric analysis of lister’s tubercle and its consequences on volar plate fixation of distal radius fractures. J Hand Surg. 33(10):1716–1719CrossRef Clement H, Pichler W, Nelson D, Hausleitner L, Tesch NP, Grechenig W (2008) Morphometric analysis of lister’s tubercle and its consequences on volar plate fixation of distal radius fractures. J Hand Surg. 33(10):1716–1719CrossRef
32.
go back to reference Benson EC, DeCarvalho A, Mikola EA, Veitch JM, Moneim MS (2006) Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop. 451:218–222CrossRefPubMed Benson EC, DeCarvalho A, Mikola EA, Veitch JM, Moneim MS (2006) Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop. 451:218–222CrossRefPubMed
33.
go back to reference Musgrave DS, Idler RS (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg. 30(4):743–749CrossRef Musgrave DS, Idler RS (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg. 30(4):743–749CrossRef
34.
go back to reference Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN (2007) Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand N Y N. 2(3):144–150CrossRef Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN (2007) Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand N Y N. 2(3):144–150CrossRef
35.
go back to reference Ljungquist KL, Agnew SP, Huang JI (2015) Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth. J Hand Surg. 40(5):940–944CrossRef Ljungquist KL, Agnew SP, Huang JI (2015) Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth. J Hand Surg. 40(5):940–944CrossRef
36.
go back to reference Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND (2015) Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg. 40(3):505–507CrossRef Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND (2015) Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg. 40(3):505–507CrossRef
37.
go back to reference Ozer K, Wolf JM, Watkins B, Hak DJ (2012) Comparison of 4 fluoroscopic views for dorsal cortex screw penetration after volar plating of the distal radius. J Hand Surg. 37(5):963–967CrossRef Ozer K, Wolf JM, Watkins B, Hak DJ (2012) Comparison of 4 fluoroscopic views for dorsal cortex screw penetration after volar plating of the distal radius. J Hand Surg. 37(5):963–967CrossRef
38.
go back to reference Brunner A, Siebert C, Stieger C, Kastius A, Link B-C, Babst R (2015) The dorsal tangential X-ray view to determine dorsal screw penetration during volar plating of distal radius fractures. J Hand Surg. 40(1):27–33CrossRef Brunner A, Siebert C, Stieger C, Kastius A, Link B-C, Babst R (2015) The dorsal tangential X-ray view to determine dorsal screw penetration during volar plating of distal radius fractures. J Hand Surg. 40(1):27–33CrossRef
39.
go back to reference Vaiss L, Ichihara S, Ramirez DGH, Hendriks S, Liverneaux P, Facca S (2015) A comparative study about ionizing radiation emitted during radiological “skyline” view of the wrist in pronation versus supination. Eur J Orthop Surg Traumatol Orthopédie Traumatol 25(2):309–311CrossRef Vaiss L, Ichihara S, Ramirez DGH, Hendriks S, Liverneaux P, Facca S (2015) A comparative study about ionizing radiation emitted during radiological “skyline” view of the wrist in pronation versus supination. Eur J Orthop Surg Traumatol Orthopédie Traumatol 25(2):309–311CrossRef
Metadata
Title
Comparison of lateral and skyline fluoroscopic views for detection of prominent screws in distal radius fractures plating: results of an ultrasonographic study
Authors
Olivier Herisson
Caroline Delaroche
Sandrine Maillot-Roy
Alain Sautet
Levon Doursounian
Adeline Cambon-Binder
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2759-y

Other articles of this Issue 10/2017

Archives of Orthopaedic and Trauma Surgery 10/2017 Go to the issue