Is ultrasound superior to fluoroscopy in distal radius volar fixation?

In volar distal radius fixation, conventional and additional fluoroscopic views could not be sufficient to assess dorsal screw penetration. Ultrasound (US) has been suggested as a technique to improve this assessment. The objective was to determine the agreement between these two explorations in a clinical study. Quantify time-consuming of intraoperative US was the secondary objective.

A prospective descriptive study was performed. Thirty patients with a surgical distal radius fracture were treated with volar fixation by five consultant surgeons in a level I Trauma Centre. Final intraoperative fluoroscopic views: AP, lateral, 20º tilted lateral and Dorsal Tangential views (DTV) were performed assessing for dorsal screw protrusion. Then, ultrasound was performed to reassess dorsal cortex integrity. Those protruding screws were registered and changed.

A total of 153 screws were examined. Four protruding screws were observed with no multiple protruding screws in the same fixation. Intraoperative ultrasound detected a dorsal screw protrusion in one fixation, assessed as correct by radiological projections. Almost perfect agreement was found between DTV and US examination k = 0.83 (p < 0.001). The mean surgical time was 63 ± 20.3 min while the addition of the ultrasound, supposed an average of 4 ± 1 min more.

Ultrasound did not show a clinically significant improvement in the assessment dorsal screw penetration in distal radius fixation. A high agreement was observed between US and the described fluoroscopic views. The addition of intraoperative US was a non-significant time-consuming procedure.