Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation

Riddick, Andrew; Hickey, Ben; White, Simon

doi:10.1177/1753193411426809

Cited by 57 publications

(51 citation statements)

References 11 publications

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“…In the study by Ganesh et al, the DTV sensitivity was 100 % in detecting prominent screws in the 3rd dorsal compartment, whereas it was only 50 % in the 4th dorsal compartment and 60 % in the 2nd (23). In the study using a sawbones model, the skyline view was 83 % sensitive for detecting dorsal cortical penetration by 1 mm (24). In our study, the lowest sensitivity was found for the 4th hole and caused tenosynovitis in one case, which required a surgical revision.…”

Section: Discussionmentioning

confidence: 94%

“…There are two described techniques to achieve DTV. The fi rst (and mostly used) is with the supinated forearm inclined at 15° to the vertical X-ray beam with maximum wrist fl exion (8,12,13,21,(23)(24)(25)(26). The second is with a pronated forearm and horizontally placed fl uoroscope with the X-ray beam parallel to the dorsal aspect of the distal radius (9,27).…”

Section: Discussionmentioning

confidence: 99%

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What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Kilian¹,

Simkovic²,

Zamborský³

et al. 2019

BLL

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PURPOSE: This study aimed to specify the optimal lengths of the distal locking screws (in a female population undergoing distal radius fracture fi xation with a volar locking plate) to avoid damaging the dorsal extensor tendon compartments while preserving stability. METHODS: Twenty-fi ve female adult patients underwent volar locking plate fi xation with four 2.4 mm locking screws inserted distally. Our modifi ed dorsal tangential fl uoroscopic view (DTV) was taken perioperatively followed by postoperative CT scans to compare the accuracy in determining the distal screw lengths. RESULTS: Our modifi ed DTV was 88 %, 84 %, 88 %, and 76 % sensitive in detecting screw lengths in the fi rst, second, third, and fourth distal plate holes, respectively. According to the CT scans, none of the screws were over-penetrated in the third dorsal compartment, over-penetration was found in the second and fourth dorsal compartment. The most-accurate screw lengths in the four most distal plate holes in female distal radius fracture are 14, 20, 20, and 20 mm from the radial to the ulnar aspect. CONCLUSION: In dorsal cortex comminution, when perioperative measuring is imprecise, inserting the mostsuitable distal locking screw for problematic hole and then applying our modifi ed DTV seems to be a simpler and safer option (Tab.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Kilian¹,

Simkovic²,

Zamborský³

et al. 2019

BLL

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show abstract

“…Despite the limitations stated above, the data presented suggest that defining standard screw lengths based on the distal radius width is feasible. While the use of screws with standardized, predetermined lengths should mostly eliminate dorsal screw protrusions, a final control using the radiographic skyline view [ 30 , 31 ] or a similar technique would remain a prerequisite.…”

Section: Discussionmentioning

confidence: 99%

Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study

Synek

Borgmann

Traxler

et al. 2016

BMC Musculoskelet Disord

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BackgroundSymptomatic extensor tendon irritation is a frequent complication in volar plate osteosynthesis of distal radius fractures. It is typically caused by dorsal screw protrusion and overdrilling of the dorsal cortex. The use of self-drilling locking screws (SDLS) could overcome both causes. The practical applicability of SDLS depends on two prerequisites: (1) the feasibility of preoperative distal screw length determination, and (2) sufficient primary biomechanical stability of SDLS compared to standard locking screws (SLS).MethodsWe first assessed the feasibility of preoperative screw length determination (1): Distal radius width, depth and distal screw lengths were measured in 38 human radii. Correlations between distal radius width and depth were assessed, a cluster analysis (Ward’s method and squared Euclidean distance) for distal radius width conducted, and intra-cluster screw lengths analyzed (ANOVA). The biomechanical performance of SDLS (2) was assessed by comparison to SLS in a distal radius fracture model (AO-23 A3). 75 % distal screw length was chosen for both groups to simulate a worst-case scenario. Uniaxial compression tests were conducted to measure stiffness, elastic limit, maximum force and residual tilt. Statistics comprised of independent sample t-tests and a Bonferroni correction (p < 0.0125).Results(1) Distal radius width and depth showed a high correlation (R2 = 0.79; p < 0.001). Three distal radius width clusters could be identified: small <34 mm; medium 34–36.9 mm; large >36.9 mm. ANOVA and Tukey post-hoc analysis revealed significantly different volar-dorsal depths (p < 0.05) for nearly all screws. (2) To assess biomechanical stability nine specimens were tested each; no significant differences were found between the SDLS and SLS groups.ConclusionsThis feasibility study demonstrates that (1) distal radius width can be used as a predictor for distal screw length and (2) that SDLS provides mechanical stability equivalent to SLS. These results highlight the feasibility of applying SDLS screws in volar plate osteosynthesis at least in extraarticular fractures.

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“…In a study using a sawbones model, the sensitivity of the skyline view was 83% in detecting a screw crossing the dorsal cortical bone by up to 1 mm, while the sensitivity using an oblique pronation projection view was 77% and using a profile view 51%. 6 Two clinical studies using the skyline view showed a change in screw length in 4 of 15 patients 9 and 11 of 27 patients. 10 In our study the screw length was changed in 11 of 75 patients.…”

Section: Discussionmentioning

confidence: 99%

“…5 The accuracy of this view has been validated by experimental studies. [6][7][8] There are two published clinical series on the use of this view. 9,10 The purpose of this article is to demonstrate the utility of the skyline fluoroscopic view in detecting screws that penetrate the dorsal cortex of the distal radius that are not apparent on AP and lateral fluoroscopic views.…”

mentioning

confidence: 99%

The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

et al. 2014

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Background?Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods?Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results?No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8?mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion?Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence?IV

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Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation

Cited by 57 publications

References 11 publications

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study

The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

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