Abstract
Aim
With the current wave of enthusiasm for internal fixation with volar locking plates in the treatment of distal radial fractures, radiology of the wrist needs review.
With current standardised x-rays of the wrist there is often an appearance of intra-articular screws. This is on account of the objective of getting very distal subchondral fixation and fixation into the radial styloid. As a consequence, due to the volar tilt and radial inclination of the ‘anatomic’ wrist, fixation is often perceived and reported to be intra-articular.
It is proposed in this study that ‘standard’ wrist x-rays post-internal fixation be taken with 20° elbow flexion on the lateral view to counteract radial inclination.
The postero-anterior view should be angled 10° to view the joint without the effect of normal radial tilt.
Method and Materials
30 consecutive wrists treated by fixed angled volar fixation were analysed. In each case standard x-rays and the proposed ‘20, 10’ radiographs were obtained. The ‘20, 10’ x-rays were taken with a custom-made set of bolsters set at 20° and 10° for the Lateral and PA views. Each set of x-rays (a standard PA and lateral and the so called ‘20, 10’ proposed radiographs) were commented on by 2 Radiologists and 2 Orthopaedic Surgeons.
Results
It would appear that in both the Radiologists' and Orthopaedic surgeons' reports there was a higher degree of confidence in reporting on the 20, 10 views than on the standard views. In just over 50% of cases standard views had the appearance of intra-articular fixation while this perception was disproven with the newly proposed 20, 10 views. The correlation between Radiologist and Orthopaedic Surgeon reports was almost 100%.
Conclusion
With the current trend to volar wrist fixation we should adapt our radiology protocols. We propose 20, 10 angled x-rays as standard for post-operative wrist radiology.
