Prevention of screw penetration of the dorsal cortex in volar plating of distal end radius fracture by using dorsal tangential view

Background: The dorsal cortex penetration by a screw can leads to irritation and attritional extensor tendon injury in volar plating of distal end radius fracture. Our method in this study was to use dorsal tangential view (DTV) intraoperatively to detect screw protrusions in the dorsal cortex and replace these screws with screws of appropriate size. Methods: We have enrolled 60 patients from in patient department of orthopaedics in a rural tertiary care institute (Indian Institute of Medical Science and Research Warudi, Ta. Badnapur, Dist. Jalna, Maharashtra) having distal end radius fracture above 18 years of age planned for volar plating. DTV other than standard PA, lateral view was taken to evaluate the dorsal cortex penetration. Results: Seven patients required AP and lateral view while 14 patients needed DTV with 80% power (α=0.05, β=0.2). Conclusions: Our study concluded that additional DTV apart from standard AP and lateral view will detect the dorsal penetration of screws and can be changed intraoperatively. Thus, DTV is advised to minimise the iatrogenic extensor tendon injury by dorsal screw penetration which might be missed in lateral view.