Purpose
The 3-category rating of volar plate prominence in relation to the most volar edge
of the distal radius (the watershed line) on lateral radiographs was reliable among
a small group of surgeons and associated with the probability of flexor tendon irritation
and potential rupture. Classifications are often less reliable when tested among a
large group of practicing surgeons in different environments.
Methods
In this survey-based experiment, an international group of 115 fracture and upper
extremity surgeons viewed 1 of 4 sets of 24 lateral radiographs (96 unique lateral
radiographs) of patients with distal radius fractures who underwent volar plating
in the practice of a single surgeon using 2 types of plates. Surgeons were asked to
rate the following metrics: (1) the grade of plate prominence according to Soong,
(2) whether the plate was more prominent than the watershed line, (3) whether the
plate was separate from the bone distally, and (4) whether there is more than 5° of
dorsal angulation of the distal radius articular surface.
Results
The interobserver agreement of the classification was “fair” (κ = 0.32; 95% confidence
interval [CI] = 0.27–0.36), and grading was more reliable among surgeons who do not
supervise trainees. Volar prominence was less reliable (κ = 0.034; 95% CI = 0.013–0.055)
than plate separation from bone (κ = 0.50; 95% CI = 0.42–0.59) and more than 5° of
dorsal angulation (κ = 0.42; 95% CI = 0.35–0.48).
Conclusions
Among a large number of international practicing surgeons, the classification of volar
plate prominence in 3 categories was fair.
Clinical Relevance
The diagnosis of plate prominence might develop toward criteria with moderate reliability,
such as separation of the plate from the bone and residual angulation of the distal
radius.
Key words
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Article info
Publication history
Published online: September 05, 2022
Accepted:
July 15,
2022
Received:
November 29,
2021
Footnotes
Dr Ring has received royalties from Wright Medical (Memphis, Tennessee) for elbow plates of an amount less than USD 10,000 per year and from Skeletal Dynamics for an internal joint stabilizer elbow of an amount between USD 10,000 and USD 100,000 per year; is a Deputy Editor for Hand and Wrist, Journal of Orthopaedic Trauma, and Clinical Orthopaedics and Related Research and has received or may receive payments or benefits in the amount of USD 5000 per year; has received honoraria from meetings of the AO North America (Wayne, Pennsylvania), AO International (Davos, Switzerland), and various hospitals and universities. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
