Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation

BACKGROUND Complications related to extensor tendons have begun to increase with the use of volar plates in the treatment of distal radius fractures. In this study, we aimed to compare four-plane radiography and ultrasonography in the evaluation of dorsal cortex screw penetration following volar plate fixation. METHODS We recruited 47 patients (33 males, 14 females, mean age 37.4 years; range 18-58 years). To evaluate dorsal screw penetration in all patients, we performed radiographs at 45° pronation, 45° supination and obtained dorsal tangential graphs at maximum palmar flexion, and a wrist lateral radiograph. Wrist ultrasonography was performed in all patients. RESULTS Dorsal screw penetration was detected in 12 of the 47 patients undergoing VLP application. While there was > 2 mm screw penetration in seven patients, there was < 2 mm screw penetration in five patients. On four-plane radiographs, screw penetration > 2 mm was detected in seven patients and screw penetration < 2 mm was detected in two patients. On four-plane radiography, dorsal screw penetration was not detected in three out of five patients, who were shown to have < 2 mm screw penetration by ultrasonography. In addition to perioperative four-plane radiographs are also required to detect dorsal cortex penetration in patients undergoing VLP due to distal radius fracture. However, the detection of screw penetrations < 2 mm is more likely with ultrasonography compared to four-plane radiography. CONCLUSION We recommend that dorsal cortex screw penetration should be evaluated with perioperative ultrasonography. TRIAL REGISTRATION Research Registry, researchregistry3344 , Registered 10 January 2017.