The Effect of Dorsal Screw Prominence in the Radial Shaft of Distal Radius Fractures Treated with Volar Locked Plating
Nicholas Pulos, MD; Brent R DeGeorge, MD, PhD; Alexander Y. Shin, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN
Dorsal screw prominence in volar locked plating of distal radius fractures puts extensor tendons at risk for irritation and rupture. The purpose of this study is to determine if prominent radial shaft screws in volar locked plating of distal radius fractures increase the risk of tendon irritation, tendon rupture or hardware removal.
A retrospective review was conducted to identify all patients who had undergone volar locked plating of distal radius fractures from May of 2003 and May of 2015. All patients with radiographic follow-up in our electronic medical record were included. 606 distal radius fractures in 584 patients were identified. Mean follow-up was 9.2 ± 12.8 months. Clinical data were reviewed including demographic variables, extensor tendon irritation, extensor tendon rupture, and hardware removal. Each patient's most immediate lateral post-operative radiograph was reviewed. The most prominent cortical screw was identified and measured from the dorsal cortex of the radial shaft to the tip of the screw.
Of the 606 distal radius fractures managed with volar plate fixation, 42 (6.9%) underwent subsequent hardware removal at a mean 14.9 ± 18.7 months. Ten patients (1.7%) were found to have clinically significant extensor tendon irritation including two patients (0.33%) with extensor tendon rupture. The average screw was 1.4 mm proud of the dorsal radial cortex (range: 0 to 4.9 mm). 20.9% of screws were greater than 2 mm proud. Comparing patients who underwent hardware removal to those who did not, there was no statistically significant difference in screw prominence (1.53 mm v. 1.43 mm, p = 0.46) or proportion of patients with screws greater than 2 mm (20.6% v. 26.2, p = 0.39). There was no statistically significant difference between shaft screw prominence and extensor tendon irritation or rupture (p = .23 and p = .38, respectively).
A post-hoc power analysis demonstrated 80% power to detect a 4% difference in hardware removal rates between patients with screws greater than 2 mm proud and those without.
Volar locked plating of distal radius fractures is associated with extensor tendon irritation. It appears the effect of dorsal screw prominence of radial shaft screws is not significant within a range of 2 mm, a common screw length interval. Measuring screw lengths in the radial shaft with a depth gauge is clinically beneficial to patients and educational for trainees. However, this study does not support the downsizing of prominent screws 2 mm or less.
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