Screws length during plate osteosynthesis of distal radius: how to avoid a mistake?

Abstact. One of the most common complications after volar locking plate fixation of distal radius is extensor tendon complications as a result of incorrect screwlength assessment and dorsal screw tips penetration leading to a conflict between extensor tendons and screws. The aim of the study is to analyze complications of volar locking plate fixation of distal radius related to extensor tendons as a result of using incorrect screwslength and its protrusion into extensor compartments and to offer preventive measures of such complications to improve functional results of surgical treatmentof distal radius fractures. Material and Methods. We analyzed 319 patients with distal radius fractures (164 female and 155 male) treated in the period from 2014 to 2018 using volar locking plate fixation. The mean age was 57,2+0,8 years (18-89 years). During plate osteosynthesis in all cases for screw length assessment and exclusion of screws protrusion past dorsal cortex of distal radius we used a depth gauge. In addition, in 156 cases (till 2016 - the main group of patient) for intraoperative assessment of screws length we used standart fluoroscopic views (AP and lateral), whereas since 2016 (163 patients - control group) we started to use additional third view - tangential view. Results. All screws that were seen to protrude past the dorsal cortex of the distal radius and required exchange were recorded. In 74 of156 cases (47,4%) despite the usage of depth gauge, we found protrusion of one or more screws on lateral view required their intraoperative exchange for shorter ones. Extensor tendon tendinitis was diagnosed in 27 patients of the main group (17,3%) in post-op period. In 16 cases this required screws removal and in 8 cases long screws were exchanged for shorter ones. In 3 patients after 6 weeks post-op the implants were removed at all. In 1 patient of the main group (0,64%) 3,5 month after volar locking plating of distal radius there was a spontaneous rupture of extensor pollicis longus tendon, which required tendon reconstruction. In 131 patients of control group (80,4%) after confirmation of correct screws length by intraoperative AP and lateral views, during tangential view we determined dorsal screw tips penetration. In all cases screws were exchanged with shorter ones. Conclusions. For prevention of extensor tendon-related complications and adequate intraoperative assessment of screw length during volar locking plate fixation of distal radius fracture, it is necessary to combine usage of a depth gauge with X-ray control with obligatory use of tangential view.