Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

Minke Bergsma, Job N. Doornberg, Robin Duit, Aimane Saarig, David Worsley, Ruurd Jaarsma, Lleyton Hewitt Study Group, Greg Bain, Bhavin Jadav, Mark Inglis, Bas de Hartog, John White, Luke Johnson, Jaideep Rawat, Saleem Hussenbocus, Simon MacLean, Robin Duit, Alfred Roy, Karim Kantar, Nathan Eardley-HarrisStephanie Lennon, Christy Graff, Danny Awwad, Michael Farnartzis, Alister Thomas, Job Doornberg, David Worsley, Ruurd Jaarsma, Anthony Samson, Afsana Hasan, Vikas Singh, Arthur Turow, Deepa Ajay Taranath, Tendai Mwaturura

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Purpose: The purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients. Materials and methods: 100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative –screw– revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated. Results: Additional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12–26 mm), and these were changed to a mean length of 20 mm (range, 10–22 mm). Conclusion: In this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard.

Original languageEnglish
Pages (from-to)1810-1815
Number of pages6
Issue number10
Publication statusPublished - Oct 2018


  • Distal radius fracture
  • Dorsal tangential view
  • Open reduction and internal fixation
  • Protruding screws
  • Volar locking plate


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