Sensitivity and Specificity of Skyline and Carpal Shoot-Through Fluoroscopic Views of Volar Plate Fixation of the Distal Radius: A Cadaveric Investigation of Dorsal Cortex Screw Penetration

Hand : Official Journal of the American Association for Hand Surgery
T Kyle StoopsFrancisco Schwartz-Fernandes

Abstract

Volar plate fixation of distal radius fractures can result in soft tissue injuries. Abnormal contour of the dorsal cortex of the distal radius provides difficulties in discerning screw penetration on standard radiographs. The skyline and carpal shoot-through views are additional views to improve dorsal cortex visibility. We report on the sensitivity and specificity of determining screw protrusion with these views. Seven fresh frozen cadavers were instrumented with a distal radius volar locking plate. Initial screw length was determined by depth gauge measurement. A dorsal dissection of the wrist was performed to detect screw penetration. Protruding screws were documented and replaced with screws of the appropriate length and deemed as baseline. Screws were then sequentially lengthened by 2 and 4 mm. Skyline and carpal shoot-through views were obtained at baseline, 2 mm, and 4 mm. The images were randomized and compiled into an untimed survey asking orthopedic surgeons to determine whether screws were penetrating through the dorsal cortex. Based on depth gauge measurements, 4 out of 44 (9.1%) volar plate locking screws penetrated the dorsal cortex, as confirmed with dorsal dissection. Sensitivities for the skyline and carpal sho...Continue Reading

References

Oct 23, 1997·The Journal of Hand Surgery·D RingH Hastings
Mar 20, 2002·The Journal of Hand Surgery·Jorge L Orbay, Diego L Fernandez
Oct 18, 2003·The Journal of Bone and Joint Surgery. American Volume·Tamara D RozentalDavid J Bozentka
Sep 10, 2008·Hand : Official Journal of the American Association for Hand Surgery·Steven D MaschkeJeffrey N Lawton
Jan 6, 2009·The Journal of Hand Surgery·Andrew D Thomas, Jeffrey A Greenberg
Aug 5, 2009·The Journal of Bone and Joint Surgery. American Volume·Kevin C ChungJohn D Birkmeyer
Nov 9, 2011·The Journal of Hand Surgery, European Volume·A P RiddickS P White
Mar 22, 2013·Journal of Orthopaedic Trauma·Luigi TaralloFabio Catani
Nov 22, 2014·Hand : Official Journal of the American Association for Hand Surgery·Donald DolceScott Edwards

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Citations

Jul 1, 2020·The Bone & Joint Journal·David W G LangerhuizenJob N Doornberg
Apr 25, 2021·Hand Clinics·Jeremy E Raducha, Christopher J Got
Jan 1, 2021·Orthopaedics & Traumatology, Surgery & Research : OTSR·Álvaro Toro-AguileraJosep M Segur

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