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. 2024 Nov 12;12(11):e6320.
doi: 10.1097/GOX.0000000000006320. eCollection 2024 Nov.

Dorsal Cortical Screw Penetration in Volar Distal Radius Plating: Comparison of 3 Fluoroscopic Views

Marco Guidi  1 , Leonardo Previ  2 , Daniele Mazza  2 , Stefano Lucchina  3 , Cesare Fusetti  4 , Shahar Beni Goldshmidt  5 , Agostino Di Maro  5 , Graziano Uccheddu  6 , Vito Mantini  7 , Jolie Bruno  8 , Martin Riegger  5
Affiliations

Dorsal Cortical Screw Penetration in Volar Distal Radius Plating: Comparison of 3 Fluoroscopic Views

Marco Guidi et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The skyline or dorsal tangential view (DTV) and the carpal shoot-through (CST) have been developed to enhance the intraoperative examination of the distal radius's dorsal cortex during open reduction and internal fixation with volar plates. This study aimed to assess the lateral view (LV), DTV, and CST's effectiveness in showcasing screws that penetrate the dorsal cortex.

Methods: Eighty patients, comprised of 42 women and 38 men with an average age of 53 years, underwent volar locking plate fixation for displaced distal radius fractures. The procedures incorporated the use of intraoperative LV, DTV, and CST views. Every view was meticulously examined to record the presence of screws that breached the dorsal cortex of the fractured region.

Results: Only 2 screws were found to protrude the dorsal cortex in the LV, demonstrating 100% specificity and 18.8% sensitivity. On the DTV, 9 screws were detected with the same specificity but increased sensitivity (75%). On the CST, all 12 screws were identified, making for 100% specificity and sensitivity. Of 501 distal screws, 13 (2.54%) penetrated the dorsal cortex, with an average length of 1.34 mm (range, 0.5-2 mm). These screws were subsequently replaced with shorter screws in 12 of 80 patients.

Conclusions: The findings show that the CST and DTV are more precise and accurate than LV in identifying dorsal screw protrusion during distal radius volar plating. To minimize the likelihood of subsequent complications, it is highly advisable to implement these views in all procedures.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information.

Figures

Fig. 1.
Fig. 1.
Locking compression VA-LCP two-column distal radius volar plate 2.4 (De Puy Synthes Companies) with (A) 6 or (B) 7 distal holes were used. The screw holes have been numbered progressively starting with the most radial and distal one.
Fig. 2.
Fig. 2.
Position to be maintained for each view: A, DTV. B, CST view. C, LV.
Fig. 3.
Fig. 3.
Skyline view (DTV). Black asterisk: comminution of dorsal fracture. Red dashed line: dorsal margin of radius and sigmoid notch. White asterisk: screw at position 3 changed for protrusion beyond the dorsal cortex of the radius.
Fig. 4.
Fig. 4.
CST. Red dashed line: dorsal margin of radius and sigmoid notch. All screws have the correct length and do not protrude beyond the dorsal cortex of the distal radius.
Fig. 5.
Fig. 5.
Clinical case report with intraoperative fluoroscopy. A, LV fails to detect a screw that is too long in the third compartment (black asterisk). The protruding screw is clearly visible in (B) with a CST view (white asterisk) and in (C) with DTV (black asterisk). D, The intraoperative control after the screw change.
See this image and copyright information in PMC

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