Abstract

Objectives: We aimed to determine the appropriate screw lengths to prevent dorsal screw penetration in fixation with volar plate for distal radius fractures and to demonstrate the danger of relying on intraoperative fluoroscopic views to determine screw penetration.
Methods: Magnetic resonance imaging (MRI) scans of fifty patients’ wrists conducted with a 1.5-T scanner (Siemens, Erlangen, GY) were used. MRI scans evaluated independently and at different times by two musculoskeletal specialist radiologists and the means of each measurements from each patient’s images were used for the statistical analysis. All measurements were performed with standard MRI evaluation techniques. Volar to dorsal measurements were performed for extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), Lister’s tubercle (LT), extensor pollicis longus (EPL) and extensor digitorum communis (EDC) tendon compartments to find the real screw length and compared with the lateral view of the distal radius especially Lister’s tubercle.
Results: Patients ages ranged from 20 to 64 years and the mean age was 39.9 13.2 years. For female patients, the mean height lengths for LT and ECRL, ECRB, EPL and EDC compartments were 20.72.5 mm, 13.01.1 mm, 16.41.3 mm, 18.11.1 mm and 17.01.0 mm, respectively (Fig 2). For male patients, the mean height lengths for LT and ECRL, ECRB, EPL and EDC compartments were 23.52.2 mm, 15.11.8 mm, 18.92.4 mm, 20.62.1 mm and 19.52.4 mm, respectively.
Conclusion: To prevent extensor tendon injury/rupture, downsizing of screws is recommended as is careful checking of screw length on intraoperative fluoroscopic views often performed in multiple planes.

Key words: distal radius fracture, extensor tendon rupture, complication, screw penetration, volar plate.