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Avoiding screw overlength using dorsal horizon view in palmar plate osteosynthesis of distal radius fractures: a prospective randomized trial

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Distal radius fractures are the most commonly reported fractures in adults. Treatment has changed in recent years to open reduction and palmar plate fixation. Penetration of the dorsal screw, however, is a well-known complication. Intraoperative anteroposterior and lateral radiographs lack the exact assessment of dorsal screw length and intraoperative measurement is therefore very likely to be inaccurate in a comminuted dorsal radial cortex. Secondary extensor tendon ruptures are reported in up to 6% following palmar plate fixation of distal radius fracture.

Materials and methods

A prospective randomized trial was performed to assess the value of the dorsal horizon view. The hypothesis was that the traditional anteroposterior and lateral fluoroscopic views aided by an axial view of the dorsal part of the radius, named dorsal horizon view, could prevent dorsal screw penetration. A total of 40 patients, 6 male and 34 female, were included in the study. Standardized anteroposterior and lateral radiographs were performed intraoperatively in 18 patients (standard group = control group). In 22 patients, intraoperative axial fluoroscopic views (dorsal horizon view) were added to anteroposterior and lateral images (horizon group). Numbers of intraoperative screw changes due to the two different radiological examinations were analyzed as well as exact postoperative CT guided measurement of screw length.

Results

The total numbers of intraoperative screw changes were significantly higher in the horizon group. Forty-two screws were changed in 15 patients in the horizon group while only 8 screws were changed in 3 patients in the standard group. Postoperative computed tomography scans showed significantly lower total numbers of perforating screws in the horizon group with 11 screws in 22 patients compared to 20 screws in 18 patients in the standard group (p = 0.02).

Conclusions

Based on the results of this study, the dorsal horizon view improves the assessment of the correct screw length and should routinely be used in palmar plate osteosynthesis of distal radius fractures. Since screw protrusion cannot be absolutely ruled out using the dorsal horizon view, monocortical drilling or screw downsizing is still mandatory.

Trial registration

This clinical trial was not registered because it was a clinical examination without any experimental techniques.

Level of evidence

2.

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Data availability

The data that support the findings of this study are available from the corresponding author, Markus Lill, upon reasonable request.

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Acknowledgements

The authors thank Dr. Georg Zimmermann from PMU Salzburg, for his support in statistical analyses of the data.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Praxisgemeinschaft Unfallchirurgie, Bruneckerstrasse 2E, 6020, Innsbruck, Austria

    Markus Lill & Christian Deml

  2. Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Müllner-Hauptstraße 48, 5020, Salzburg, Austria

    Guido Wierer

  3. Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute of Sports Medicine, Alpine Medicine and Health Tourism, Medical Informatics and Technology, University for Health Sciences, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria

    Guido Wierer

  4. Department Traumatology, AUVA Trauma Center Salzburg, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria

    Markus Lill, Thomas Schauer, Philipp Schultes & Christian Windhofer

  5. Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Christian Windhofer

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  1. Markus Lill
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Contributions

ML: planned the study, did the main patient recruitment and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. GW and CW: contributed in writing the manuscript. TS: contributed in planning the study and patient recruiting. PS: contributed in patient recruiting and writing. CD: contributed in planning and writing the study.

Corresponding author

Correspondence to Markus Lill.

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Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The study protocol was reviewed and approved by the ethical board of the federal state of Salzburg on the 9.7.2016.

Informed consent

Written informed consent was obtained from all subjects before the study.

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Lill, M., Schauer, T., Schultes, P. et al. Avoiding screw overlength using dorsal horizon view in palmar plate osteosynthesis of distal radius fractures: a prospective randomized trial. Arch Orthop Trauma Surg 144, 197–204 (2024). https://doi.org/10.1007/s00402-023-05046-y

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  • DOI: https://doi.org/10.1007/s00402-023-05046-y

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