The Detection of Prominent Hardware in Volar Locked Plating of Distal Radius Fractures: Intraoperative Fluoroscopy Versus Computed Tomography
| Autor: | Devin Ganesh, Ben Service, Brian Zirgibel, Kenneth Koval |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Dorsum
Adult Male medicine.medical_specialty Computed tomography Locked plating Sensitivity and Specificity Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Intraoperative fluoroscopy Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Aged 030222 orthopedics medicine.diagnostic_test business.industry Reproducibility of Results Retrospective cohort study General Medicine Middle Aged Wrist Injuries Surgery body regions Surgery Computer-Assisted Fluoroscopy Female Tomography business Nuclear medicine Radius Fractures Tomography X-Ray Computed |
| Zdroj: | Journal of orthopaedic trauma. 30(11) |
| ISSN: | 1531-2291 |
| Popis: | To assess the utility of the dorsal tangential view (DTV) in detecting intraoperative dorsal screw penetration in distal radius fractures treated with volar locked plating.Retrospective cohort study.Academic level 1 trauma center.Skeletally mature patients where open reduction internal fixation with volar locked plating was the definitive treatment. A total of twenty-six patients were evaluated.Intraoperative anteroposterior, lateral, 20 degree tilted lateral, and DTVs were obtained through fluoroscopy in all wrists. Screw exchange and position by fluoroscopic view was recorded. A computed tomography (CT) was taken postoperatively to identify residual prominent screws.Data points included frequency of screw exchange by standard fluoroscopic views, the DTV, and residual prominent screws detected by CT.Eight constructs of thirty (27%) had prominent screws evident on the DTV but not seen on standard fluoroscopic analysis. CT identified 5 additional screws with ≥1 mm dorsal penetration not identified by the DTV. All except 1 screw was in the second dorsal wrist compartment. The DTV was 67% sensitive with a negative predictive value of 97%.It is risky and unnecessary to place bicortical screws in the distal part of a volar plate. Given that the DTV view was not sufficient to avoid dorsal screw prominence, distal screws should be intentionally 2-4 mm shorter than measured. Recent studies propose bicortical distal locking screws are not needed for sufficient construct stiffness in volar locked plating. We suggest caution when using this view to verify acceptable placement of screws in proximity to the second dorsal compartment.Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|