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

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.