Standardised post-operative radiographs for volar radial plate fixation: The "22/11 X-ray"

Abstract

The current standard post-operative X-rays 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. Aim: To determine: 1. If anatomically tilted post-operative radiographs increased the observer’s confidence with regard to assessment of screw position. 2. The intra- and inter-observer reliability of these X-rays. Materials and Methods: 30 patients’ standard and tilted (11° PA 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 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 good when the intern’s observations were excluded. Conclusion: The routine acquisition of the tilted PA radiograph can assist senior health professionals with important patient management decisions.