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J Wrist Surg 2019; 08(06): 470-476
DOI: 10.1055/s-0039-1693053
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware?

Minke Bergsma    *
1   Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
2   Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
,
Jemara Board‡   *
1   Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
,
Job N. Doornberg
1   Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
2   Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
,
Inger Sierevelt
3   Speciaized Centre of Orthopedic Research and Education, Amstelveen, the Netherlands
,
Mark Rickman
4   Department of Orthopaedic Trauma/Orthopaedics & Trauma Research Group, The Royal Adelaide Hospital, Adelaide, Australia
,
Ruurd L. Jaarsma
1   Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
,
Miryam C. Obdeijn
2   Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
› Author Affiliations Funding None.
Further Information

Publication History

06 February 2019

18 May 2019

Publication Date:
26 July 2019 (online)

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Abstract

Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons.

Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive.

Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex.

Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm.

Level of Evidence This is a Level II Study.

Keywords

flexor tendons - extensor tendons - distal radius - volar plating - MRI

Ethical Approval

This study received ethical approval from our institutional research committee (protocol: 64.18) according to the World Medical Association Declaration of Helsinki.


* Shared first authorship based on equal contribution.


 

  • References

  • 1 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (05) 316-322
    CrossrefPubMedGoogle Scholar
  • 2 Lattmann T, Dietrich M, Meier C, Kilgus M, Platz A. Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius. J Hand Surg Am 2008; 33 (07) 1135-1143
    CrossrefPubMedGoogle Scholar
  • 3 Johnson NA, Cutler L, Dias JJ, Ullah AS, Wildin CJ, Bhowal B. Complications after volar locking plate fixation of distal radius fractures. Injury 2014; 45 (03) 528-533
    CrossrefPubMedGoogle Scholar
  • 4 Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003; 27 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 5 White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am 2012; 37 (10) 2035-2040
    CrossrefPubMedGoogle Scholar
  • 6 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (04) 328-335
    CrossrefPubMedGoogle Scholar
  • 7 Nunley JA, Rowan PR. Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius. J Hand Surg Am 1999; 24 (06) 1279-1280
    CrossrefPubMedGoogle Scholar
  • 8 Orbay J. Volar plate fixation of distal radius fractures. Hand Clin 2005; 21 (03) 347-354
    CrossrefPubMedGoogle Scholar
  • 9 Fuller DJ. The Ellis plate operation for Smith's fracture. J Bone Joint Surg Br 1973; 55 (01) 173-178
    PubMedGoogle Scholar
  • 10 Limthongthang R, Bachoura A, Jacoby SM, Osterman AL. Distal radius volar locking plate design and associated vulnerability of the flexor pollicis longus. J Hand Surg Am 2014; 39 (05) 852-860
    CrossrefPubMedGoogle Scholar
  • 11 Imatani J, Akita K, Yamaguchi K, Shimizu H, Kondou H, Ozaki T. An anatomical study of the watershed line on the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures. J Hand Surg Am 2012; 37 (08) 1550-1554
    CrossrefPubMedGoogle Scholar
  • 12 Azzi AJ, Aldekhayel S, Boehm KS, Zadeh T. Tendon rupture and tenosynovitis following internal fixation of distal radius fractures: a systematic review. Plast Reconstr Surg 2017; 139 (03) 717e-724e
    CrossrefPubMedGoogle Scholar
  • 13 Fucentese SF, von Roll A, Koch PP, Epari DR, Fuchs B, Schottle PB. The patella morphology in trochlear dysplasia--a comparative MRI study. Knee 2006; 13 (02) 145-150
    CrossrefPubMedGoogle Scholar
  • 14 Inan M, Senaran H, Mackenzie WG. Center of the femoral head: a magnetic resonance imaging study. J Pediatr Orthop 2006; 26 (04) 471-473
    CrossrefPubMedGoogle Scholar
  • 15 Keser S, Savranlar A, Bayar A, Ulukent SC, Özer T, Tuncay I. Anatomic localization of the popliteal artery at the level of the knee joint: a magnetic resonance imaging study. Arthroscopy 2006; 22 (06) 656-659
    CrossrefPubMedGoogle Scholar
  • 16 McCann PA, Amirfeyz R, Wakeley C, Bhatia R. The volar anatomy of the distal radius--an MRI study of the FCR approach. Injury 2010; 41 (10) 1012-1014
    CrossrefPubMedGoogle Scholar
  • 17 Agnew SP, Ljungquist KL, Huang JI. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am 2015; 40 (06) 1102-1105
    CrossrefPubMedGoogle Scholar
  • 18 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (02) 205-215
    CrossrefPubMedGoogle Scholar
  • 19 Wurtzel CNW, Burns GT, Zhu AF, Ozer K. Effects of volar tilt, wrist extension, and plate position on contact between flexor pollicis longus tendon and volar plate. J Hand Surg Am 2017; 42 (12) 996-1001
    CrossrefPubMedGoogle Scholar
  • 20 Matityahu AM, Lapalme SN, Seth A, Marmor MT, Buckley JM, Lattanza LL. How placement affects force and contact pressure between a volar plate of the distal radius and the flexor pollicus longus tendon: a biomechanical investigation. J Hand Surg Eur Vol 2013; 38 (02) 144-150
    CrossrefPubMedGoogle Scholar
  • 21 Martineau D, Shorez J, Beran C, Dass AG, Atkinson P. Biomechanical performance of variable and fixed angle locked volar plates for the dorsally comminuted distal radius. Iowa Orthop J 2014; 34: 123-128
    PubMedGoogle Scholar
  • 22 Sügün TS, Karabay N, Gürbüz Y, Ozaksar K, Toros T, Kayalar M. Screw prominences related to palmar locking plating of distal radius. J Hand Surg Eur Vol 2011; 36 (04) 320-324
    CrossrefPubMedGoogle Scholar
  • 23 Bianchi S, van Aaken J, Glauser T, Martinoli C, Beaulieu JY, Della Santa D. Screw impingement on the extensor tendons in distal radius fractures treated by volar plating: sonographic appearance. AJR Am J Roentgenol 2008; 191 (05) W199-203
    PubMedGoogle Scholar