What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

This study aimed to specify the optimal lengths of the distal locking screws (in a female population undergoing distal radius fracture fixation with a volar locking plate) to avoid damaging the dorsal extensor tendon compartments while preserving stability.

Twenty-five female adult patients underwent volar locking plate fixation with four 2.4 mm locking screws inserted distally. Our modified dorsal tangential fluoroscopic view (DTV) was taken perioperatively followed by postoperative CT scans to compare the accuracy in determining the distal screw lengths.

Our modified DTV was 88 %, 84 %, 88 %, and 76 % sensitive in detecting screw lengths in the first, second, third, and fourth distal plate holes, respectively. According to the CT scans, none of the screws were over-penetrated in the third dorsal compartment, over-penetration was found in the second and fourth dorsal compartment. The most-accurate screw lengths in the four most distal plate holes in female distal radius fracture are 14, 20, 20, and 20 mm from the radial to the ulnar aspect.

In dorsal cortex comminution, when perioperative measuring is imprecise, inserting the most-suitable distal locking screw for problematic hole and then applying our modified DTV seems to be a simpler and safer option (Tab. 3, Fig. 4, Ref. 33).