Abstract
Abstract Background Dorsal screw tip protrusion (DSTP) with extensor tendon injury is a well-known complication of volar plating for distal radius fractures. The dorsal tangential view (DTV) and the radial groove view (RGV) have been recommended to detect DSTP. The value of these views depends on their quality and reproducibility. Aims It was the aim of this study to investigate the quality of these views before and after teaching of the involved surgeons. Methods All adult patients treated with volar plating for distal radius fractures between 10/2019 and 10/2020 were included. Prior to their first case in the study period, all involved surgeons were instructed in a standardized manner how to perform technically correct DTV and RGV. Patients from an earlier period served as controls. Image quality was rated independently by two investigators. Detection of DSTP based on fluoroscopy was documented and protruding screws were exchanged. The impact of teaching was assessed. Furthermore, reliability of DTV and RGV to detect DSTP was compared to postoperative ultrasound. Results A total of 124 patients were included in the study group, 125 patients served as controls. Interobserver agreement for the image quality was 97% for DTV and 98% for RGV. Image quality significantly improved with teaching (p<0.001). Correct images were observed in 81% vs. 58% for DTV and 81% vs. 53% for RGV. From a total of 571 evaluated screws intraoperative fluoroscopy identified 24 DSTP (4.2%) in 23 patients (18.5%). Postoperative ultrasound revealed 4 DSTP (0.8-1.2mm; 0.7%) in 4 patients (3.2%). Conclusions Teaching surgeons how to perform technically good DTV and RGV leads to a significant improvement of image quality. DTV and RGV are reliable tools to detect DSTP. However, despite correct views, some minor dorsal cortex penetrations may be missed. Thus, early further investigations are recommended in patients with extensor tendon irritation.
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