Abstract
Introduction
Careful distal locking screw insertion into the subchondral zone is necessary to obtain
proper mechanical strength of unstable distal radius fractures using volar locking
plating. However, subchondral zone screw insertion increases the risk of intra-articular
screw penetration, which may remain unrecognized during surgery due to complex distal
radial anatomy. The purpose of this study was to evaluate the role of fluoroscopic
guidance with a 45° supination oblique view technique for placing distal screws into
the subchondral zone during volar locking plating for unstable distal radius fractures
and to explore the factors associated with poor screw placement.
Methods
We retrospectively analyzed 171 wrists of 169 patients treated with variable-angle
volar locking plates for unstable radius fractures. The subchondral zone was defined
as the metaphyseal area within 4 mm of the articular margin of the distal radius.
The location of the distal locking screws and radiographic parameters, including the
teardrop angle, were measured using computed tomography scans and X-rays. Clinical
and radiographic factors were examined to determine their possible associations with
screw placement failure.
Results
Of 581 distal screws inserted, 559 screws (96.2%) were inserted into the subchondral
zone and 17 screws into the metaphyseal zone (2.9%). Five screws (0.7%) in three wrists
showed intra-articular placement: four screws were placed into the lunate fossa and
one into the scaphoid fossa. These three wrists also exhibited significantly reduced
teardrop angles. The distal screws were significantly closer to the joint line in
the lunate fossa than the scaphoid fossa (1.9 ± 0.9 mm vs. 2.8 ± 1 mm, P < 0.000).
Conclusion
The 45° supination oblique view technique is a useful fluoroscopic guiding technique
for accurate and safe distal screw placement in the subchondral zone in volar locking
plate fixation for distal radial fractures. However, a decreased teardrop angle or
extended lunate fossa should be corrected before distal screw insertion to avoid intra-articular
screw placement.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 7,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
