Application value of carpal shoot through view in the palmar plating of distal radius fractures

Abstract

Objective To explore the application value of carpal shoot through view in the palmar plating of distal radius fractures. Methods From March 2015 to May 2016, there were 62 acute distal radius fractures received various operation in our department, in which 48 patients were only performed volar locked plating. Among these 48 cases, there were 21 males and 27 fe-males, with ages ranging from 17 to 75 years (mean 43.6±10.6 years). There were 15 cases of type A, 11 cases of type B and 22 cas-es of type C distal radial fractures according to AO/OTA classification. All the operations were performed through modified Hen-ry's approach between the radial artery and flexor carpi radialis. Once achieved satisfactory reduction, we performed rigid fixation of distal radius using anatomical locking plates. In all cases, bicortical drilling was performed. Screw lengths selected measured 1 to 2 mm less than the depth gauge number avoiding dorsal cortex penetration. After plate fixation of these 48 cases, standard pos-teroanterior and lateral radiographs were taken followed by the carpal shoot through view. To obtain carpal shoot through view, the patient's forearm was maximally supinated, the elbow flexed about 60°-70°and the wrist maximally dorsiflexed. The image intensi-fier beam is directed over the base of the thenar eminence. Compare the ratio of dorsal protrusion between standard view and car-pal shoot through view, then statistical analysis was performed. After operation, CT scan was routinely taken to further test the ef-fectiveness of carpal shoot through view. Results Five cases were detected dorsal cortex screw protrusion using standard postero-anterior and lateral views (10.4%, 5/48). There were totally 16 cases (including the former 5 cases) of dorsal screw penetration un-covered by the carpal shoot through view (33.3%, 16/48. Statistically significant difference was existed between the two fluorosco-py methods. Additionally, in 2 cases, a screw had penetrated the distal radioulnar joint (DRUJ), which was only apparent on the shoot through view. All the improper screws were exchanged and again were verified by the carpal shoot through view. The overall screw exchange rate was 37.5% (18/48). Conclusion Compared with standard AP and lateral fluoroscopy, the carpal shoot through view can reliably reveals dorsal screw penetration. Meanwhile, it provides excellent visualization of DRUJ. Key words: Radius fractures; Fracture fixation, internal; Bone screws; Fluoroscopy