Study of Precision of Volar Plate Fixation in Distal End Radius Fracture Using Optimal Intraoperative Radiological Evaluation: A Prospective Observational Study

Background: Volar locking plate fixation is the preferred treatment for unstable distal end radius fractures, but inaccurate screw placement, particularly dorsal cortical penetration, can cause extensor tendon irritation or rupture. Standard anteroposterior and lateral fluoroscopic views may fail to detect such penetration. This study evaluated the precision of volar plate fixation using optimal intraoperative radiological evaluation. Material and Methods: This prospective observational study was conducted at a tertiary care center and included 80 patients with distal end radius fractures treated with volar locking plate fixation. In addition to standard anteroposterior and lateral views, dorsal tangential (skyline) and tilted views were used routinely to assess screw position and the articular surface. Any screw penetration was corrected by immediate screw exchange. Demographic data, mechanism of injury, AO fracture type, intraoperative findings, postoperative tendon irritation, and radiological parameters (radial height and volar tilt) were recorded. The association between screw penetration and tendon irritation was analyzed using Fisher's exact test. Results: The mean age was 54.55 ± 11.15 years (range 36-73), with 40 males and 40 females. Fall on an outstretched hand was the most common mechanism of injury (70%). Intra-articular fractures (AO types B and C) accounted for 80% of cases. Screw penetration was detected intraoperatively in 32 patients (40%), and all underwent screw exchange. Postoperative tendon irritation occurred in 8 patients (10%), all of whom were in the group with screw penetration (8/32, 25%), compared with none of the 48 patients without penetration; this association was statistically significant. The mean postoperative radial height was 8.2 ± 1.4 mm, and the mean volar tilt was 6.1 ± 1.9°. Conclusion: Routine use of specialized intraoperative views, including the dorsal tangential view, allowed detection and immediate correction of screw penetration in 40% of cases, with acceptable radiological restoration and a low rate of tendon irritation (10%). Screw penetration was associated with tendon irritation, supporting the integration of optimal intraoperative imaging into volar plate fixation. Comparative studies with longer follow-up are needed to confirm whether this approach reduces complications.

Keywords: Distal Radius Fracture, Volar Locking Plate, Intraoperative Fluoroscopy, Dorsal Tangential View, Screw Penetration, Tendon Irritation.