Abstract
Background Volar plating for distal radius fractures exposes the risk of extensor tendon rupture,
mechanical problems, and osteoarthritis due to protruding screws.
Purposes The purpose of this review was to identify the best intraoperative diagnostic imaging
modality to identify dorsal and intra-articular protruding screws in volar plating
for distal radius fractures.
Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines
were followed for this review. In vitro and in vivo studies that analyzed the reliability,
efficacy, and/or accuracy of intraoperatively available imaging modalities for the
detection of dorsal or intra-articular screw protrusion after volar plating for distal
radius fractures were included.
Results Described additional imaging modalities are additional fluoroscopic views (pronated
views, dorsal tangential view [DTV], radial groove view [RGV], and carpal shoot through
[CST] view), three-dimensional (3D) and rotational fluoroscopies, and ultrasound (US).
For detection of dorsal screw penetration, additional fluoroscopic views show better
results than conventional views. Based on small (pilot) studies, US seems to be promising.
For intra-articular screw placement, 3D or 360 degrees fluoroscopy shows better result
than conventional views.
Conclusion Based on this systematic review, the authors recommend the use of at least one of
the following additional imaging modalities to prevent dorsal protruding screws: CST
view, DTV, or RGV. Tilt views are recommended for intra-articular assessment. Of all
additional fluoroscopic views, the DTV is most studied and proves to be practical
and time efficient, with higher efficacy, accuracy, and reliability compared with
conventional views.
Level of Evidence The level of evidence is Level III.
Keywords
distal radius fracture - volar plate - screw penetration - dorsal - intra-articular
