title: The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures.
abstract: 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.
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Vaiss
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France ; Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichihara
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hendriks
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Chihab
authors.initials: C
authors.lastname: Taleb
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Liverneaux
authors.affiliation: Department of Hand Surgery, Strasbourg University Hospital, Illkirch, France.
authors.forename: Sybille
authors.initials: S
authors.lastname: Facca
keywords: distal radius; screw; skyline; tendon rupture; volar plate