Re: Pichler et al. Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis. J Hand Surg Eur. 2009, 34: 598–602

Detecting dorsal screw penetration following volar plate fixation of the distal radius – A validation study in a saw bone model

“…The dorsal skyline in comparison, creates a sharp contrast in density of air and the distal radius, can lead to overexposure and difficulty obtaining a useful image. 17,22 In a study assessing the accuracy of the skyline versus conventional views, the authors had to manipulate the image to standardise the contrast, something that is not possible intra-operatively. 16 The dorsal skyline has been reported to result in intra-operative screw exchanges of 15-50% of cases, 6,23,24 showing that it provides a useful clinical adjunct to the lateral view.…”

Dorsal Tangential View of the Wrist to Detect Screw Penetration to the Dorsal Cortex of the Distal Radius after Volar Fixed-Angle Plating

“…c Arrows show prominent landmarks on the dorsal aspect of the distal radius, from left to right, radial styloid, Lister's tubercle, dorsal corner of the distal radioulnar joint on the radial side 1 and 2 show the projection of the X-ray beams of the lateral and pronation views, respectively. Note that fluoroscopic images are unable to detect any screw penetration in colored zone underneath arrow #2 been reported by Jacob et al using an upright full-size C-arm [6]. Authors on their letter to the editor have shown an upright C-arm used to obtain an image in the vertical plane and reported having difficulty getting a clear picture when the wrist is swollen without any comparison provided to standard views of the wrist.…”

“…Despite their judicious use intraoperatively, dorsal screw penetration may still be unrecognized, particularly at the ulnar side of the Lister's tubercle [14]. In this study using a mini C-arm intraoperatively, we obtained dorsal tangential view (DTV) along with standard views to detect dorsal screw penetration to the distal aspect of the radius [6].…”

Intraoperative Imaging of the Distal Radioulnar Joint Using a Modified Skyline View

“…We placed the model into combinations of the following wrist and forearm positions to modify the originally described skyline view 3 and acquired fluoroscopic images: (1) with the wrist in maximal extension or maximal flexion; (2) with the forearm in full supination, neutral position, or full pronation; and (3) with volar or dorsal angulation of the longitudinal forearm axis (10°to 15°) relative to the x-ray path as described by Jacob and Clay. 3 This resulted in 12 different possible positioning setups of the models. We angled the forearm slightly radially or ulnarly to match the anatomic inclination of the sigmoid notch in the coronal plane.…”