Penetration of the dorsal screw when treating distal radius fractures with volar locking plates is an avoidable complication that causes lesions of the extensor tendon in between 2% and 6% of patients. We examined axial fluoroscopic views of the distal end of the radius to observe small amounts of dorsal screw penetration, and determined the ideal angle of inclination of the x-ray beam to the forearm when making this radiological view.
Six volar locking plates were inserted at the wrists of cadavers. The actual screw length was measured under direct vision through a dorsal approach to the distal radius. Axial radiographs were performed for different angles of inclination of the forearm at the elbow.
Comparing axial radiological measurements and real screw length, a statistically significant correlation could be demonstrated at an angle of inclination between 5° and 20°. The ideal angle of inclination required to minimise the risk of implanting over-long screws in a dorsal horizon radiological view is 15°.
Cite this article: Bone Joint J 2013;95-B:1101–5.
- Distal radius fracture
- Dorsal horizon view
- Intra-operative image intensifier
- Extensor tendon rupture
- Screw penetration
- Volar locking plates
The authors would like to thank J. Willisegger for creating Figure 1.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by D. Rowley and first-proof edited by G. Scott.
- Received November 20, 2012.
- Accepted March 14, 2013.
- ©2013 The British Editorial Society of Bone & Joint Surgery