The Anterior-Posterior Diameter of Radial Shaft for Predicting Appropriate Length of Distal Screws in Volar Plating for Distal Radius Fractures

Jaeseung Hur; Bong Gun Lee; Sihoon Choi; Kwang-Hyun Lee

doi:10.12790/ahm.2019.24.4.294

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Hur, Lee, Choi, and Lee: The Anterior-Posterior Diameter of Radial Shaft for Predicting Appropriate Length of Distal Screws in Volar Plating for Distal Radius Fractures

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Archives of Hand and Microsurgery 2019; 24(4): 294-302.

Published online: 29 November 2019

DOI: https://doi.org/10.12790/ahm.2019.24.4.294

The Anterior-Posterior Diameter of Radial Shaft for Predicting Appropriate Length of Distal Screws in Volar Plating for Distal Radius Fractures

Jaeseung Hur^1,^*, Bong Gun Lee^2,^*, Sihoon Choi², Kwang-Hyun Lee²

¹Department of Orthopedic Surgery, Seouldaejeong Hospital, Cheonan, Korea.

²Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea.

Corresponding author: Kwang-Hyun Lee. Department of Orthopedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. TEL: +82-2-901-3114, FAX: +82-2-2299-3774, leegh@hanyang.ac.kr

Equal contributor:

*Jaeseung Hur and Bong Gun Lee contributed equally to this work.

Received 29 August 2019 Revised 21 October 2019 Accepted 22 October 2019

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Extensor tendon complications associated with dorsal screw penetration following volar plating of distal radius fracture have been reported widely. The aim of this study was to find the anatomical index to predict the appropriate length of screw.

Methods

Three-dimensional computed tomography (CT) scans of distal radius were performed after removal of volar plate. According to the extensor compartments and Lister tubercle, we divided the distal radius into four groups in axial view in CT. Through sagittal view, we measured volar cortex to dorsal cortex in parallel with the extension of screw trace and anatomical index (lunate depth, anterior-posterior diameter of radius shaft). Statistical analysis was performed with ANOVA and linear regression analysis.

Results

The measurable traces of screw were 371 in males and 1,091 in females. The average value was 17.59 mm, 20.72 mm, 20.31 mm, and 19.1 mm in each group for males, and 15.75 mm, 18.76 mm, 18.04 mm, and 17.22 mm for female patients. The anterior-posterior diameter of radius in which the screw was inserted to oblong hole moderately correlated with the extension of screw trace in the third and fourth compartments.

Conclusion

The anterior-posterior diameter of radius at level of oblong hole can be used to predict appropriate length of distal screw for volar plating of distal radius fractures.

Keywords: Radius fractures, Bone plates, Bone screws

Figures and Tables

Fig. 1

The dorsal cortex of distal radius was divided into four groups by the extensor compartment and Lister's tubercle (1: second extensor compartment, 2: Lister's tubercle, 3: third extensor compartment, 4: fourth extensor compartment, A: extensor carpi radialis longus, B: extensor carpi radialis brevis, C: extensor pollics longus, D: extensor digitorum communis).

Fig. 2

The hole after removal of distal screws in three-dimensional reconstructed image defining dorsal cortical screw penetration.

Fig. 3

The length between volar cortex and dorsal cortex, which is the extension of screw traces of distal screw in sagittal image, were defined as the appropriate length of screw.

Fig. 4

The anatomical index for predicting appropriate length of screw. (A) The anteroposterior diameter of in shaft of radius at level of oblong hole. (B) The lunate depth in sagittal image.

Table 1

Demographic data

Values are presented as number only, mean±standard deviation, or number (%).

Rt: right, Lt: left.

Table 2

The number of screw penetration analyzed by three-dimensional reconstruction image

1: second compartment, 2: Lister's tubercle, 3: third compartment, 4: fourth compartment.

Table 3

The appropriate length of screw and anatomical index in males

SD: standard deviation, Min: minimum, Max: maximum, 1: second compartment, 2: Lister's tubercle, 3: third compartment, 4: fourth compartment, AP: anteroposterior

^*There was no statistically significant difference between groups 2 and 3 but with the other groups.

Table 4

The appropriate length of screw and anatomical index in female

SD: standard deviation, Min: minimum, Max: maximum, 1: second compartment, 2: Lister's tubercle, 3: third compartment, 4: fourth compartment, AP: anteroposterior.

^*The average length of appropriate screw was significantly different in all groups.

Table 5

The correlation of optimal length of screw with anatomical index in males

r²: explanatory power, S: slope, I: Intercept, AP: anteroposterior.

The explanatory power of the second compartment and Lister's tubercle with all anatomical indices were less than 10%.

Table 6

The correlation of optimal length of screw with anatomical index in females

r²: explanatory power, S: Slope, I: Intercept, AP: anteroposterior.

The explanatory power of the second compartment and Lister's tubercle with all anatomical indices were less than 10%.

Table 7

The safe length of distal screw calculated by regression equation for clinical application

AP: anteroposterior, Cal: the calculated value by regression equation, Min: the maximal acceptable length of distal screw, Max: the minimal length of distal screw for bi-cortical fixation.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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ORCID iDs: Kwang-Hyun Lee
https://orcid.org/0000-0002-3060-3916
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