Standardised post-operative radiographs for volar radial plate fixation
the '22/11 X-ray'
Keywords:
anatomically tilted, radiographs, X-rays, distal radius, volar locking plateAbstract
BACKGROUND: The current standard post-operative radiographs for patients who have had volar locking plate fixation for a distal radius fracture may give the impression of intra-articular screw placement due to the normal anatomic inclination of the radiocarpal joint. Our aim was to determine: 1) if anatomically tilted post-operative radiographs increased the observer's confidence with regard to assessment of screw position, and 2) the intra- and inter-observer reliability of these radiographs.
METHODS: Thirty patients' standard and tilted (11 ° postero-anterior and 22° lateral) post-operative radiographs were assessed by an orthopaedic intern, registrar, consultant, and a radiologist on two occasions. Single and combined views were analysed.
RESULTS: There was no difference in confidence of assessment, but there was a significant change of assessment of actual screw position with fewer intra-articular penetrations reported with the tilted PA view. There was low intra-observer reliability except for the consultant orthopaedic surgeon. Inter-observer reliability was substantial when the intern's observations were excluded.
CONCLUSIONS: The routine acquisition of the tilted PA radiograph can assist senior health professionals with important patient management decisions.
LEVEL OF EVIDENCE: Level II.