Volar Locking Plate Fixation of Distal Radius Fractures: Use of an Intra-Operative ‘Carpal Shoot Through’ View to Identify Dorsal Compartment and Distal Radioulnar Joint Screw Penetration

Abstract

Using the hand and carpus to minimise the contrast in X-ray penetration, the dorsal cortex of the distal radius may be imaged intra-operatively and dorsal compartment screw penetration detected in cases with significant multifragmentation when screw measurement is difficult. This view potentially reduces the risk of post-operative pain and extensor tendon injury and also provides excellent visualisation of the DRUJ.

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.…”

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

“…The one shortcoming of the skyline view is the potential for overexposure of the image, as the image intensifier has difficulty regulating radiation dose based on perceived density. 6 This is thought to be attributed to the palmar flexion at the wrist. We also found this to be a challenge, and noted that more images were needed to obtain an acceptable skyline view compared with the carpal shoot-through view.…”

“…4,5,7,10,11,16 A number of fluoroscopic views have been described to increase the ability to detect dorsal cortex screw penetration. [4][5][6]8,10,11 The skyline view and carpal shootthrough views have been developed to increase visibility of the dorsal cortex. These views place the arm in supination with elbow flexion of approximately 70° to 75° (15°-20° inclination from vertical).…”

“…The skyline view palmar flexes at the wrist, whereas the carpal shoot-through view dorsiflexes at the wrist, providing visibility of the dorsal cortex. 6,11 In this cadaveric study, we attempt to achieve 2 goals: (1) determination of the accuracy of using the depth gauge independently to measure the appropriate screw length; and (2) determination of the specificity and sensitivity of using the skyline and carpal shoot-through views intraoperatively to detect screw penetration through the dorsal cortex.…”

Morphometric anatomic study and clinical significance of lunate fossa

“…Radius distal volar plak uygulamalarının daha sağlıklı yapılabilmesi için anatomik [4] radyolojik ve üç boyutlu lazer tarayıcılar [5][6][7] ile ilgili çalışmalar bildirilmiştir. Volar plak uygulamalarında sadece rönt-gen grafilerine bakıp vida boyları ve durumu hakkın-da karar verilmesinin hatalı olabileceği morfometrik anatomik ve tomografik çalışmalarda gösterilmiştir.…”