title: Improving accuracy and confidence in distal radius volar plate screw placement through supplemental radiography: examining specialty, education, and experience levels.
abstract: BACKGROUND
  The purpose of this study was to assess the extent to which a supplemental radiographic view increases accuracy and confidence ratings when determining screw placement in volar plating of distal radius fractures for evaluators of different specialties and experience levels.
  
  
  METHODS
  Thirty-four distal radius fractures treated with volar plate fixation were imaged using standard AP and lateral, and supplemental lateral tilt views. Each case was then evaluated for penetration of distal screw tips into the articular space. Sixty-five physicians then completed a two-phase analysis and survey of these cases. In the first phase, presentation consisted only of AP and lateral views; in the second, the lateral tilt view was added. Participants were asked to determine whether distal screws penetrated the joint and rate their confidence in the determination. Assessments were scored for correctness; changes in accuracy and confidence levels between phases were analyzed using paired t tests. Comparisons between groups were performed by ANOVA.
  
  
  RESULTS
  Supplementation increased accuracy and confidence in all position, specialty, and experience groups. Confidence scores were significantly higher following evaluation of three views versus two views. Residents exhibited the greatest improvements in accuracy and confidence. For first-phase (standard view) assessments, accuracy scores were significantly better for attendings with less than 10 years post-fellowship experience than those with more.
  
  
  CONCLUSIONS
  A supplemental view of the distal radius combined with AP and lateral views significantly improves the ability of all evaluators, regardless of specialty or training level, to correctly assess placement of fixation screws. The greatest improvements are seen for resident trainees.
authors.affiliation: Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA.
authors.forename: Archit
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA.
authors.forename: Maya Deza
authors.initials: MD
authors.lastname: Culbertson
authors.affiliation: Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Lahey
authors.affiliation: Department of Anesthesiology & Pain Medicine at St. Elizabeth's Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135 USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Semenovski
authors.affiliation: Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Choueka
keywords: Arthrodesis; DVR plate; Distal radius fracture; Fixation screw; Fluoroscopy; Hardware placement; Intra-articular; Postoperative evaluation; Tilt radiography; Volar plate