title: 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: BACKGROUND
  We report our experience using a 'carpal shoot through' view of the distal radius to identify dorsal compartment screw penetration intra-operatively when performing volar plating of the distal radius.
  
  
  METHODS
  A prospective study of 42 patients (mean age 56 years) with acute distal radius fractures treated with open reduction internal fixation was undertaken. Surgical fixation was performed using a volar locking plate in all patients. After plate application, inclined posteroanterior and lateral radiographs were taken followed by the carpal shoot through view.
  
  
  RESULTS
  In six cases (14 %), the carpal shoot through view revealed dorsal screw protrusion, which was not detectable on standard PA and lateral views. In one case, a screw had penetrated the distal radioulnar joint (DRUJ), which was only apparent on the shoot through view. The overall screw exchange rate was 17 %.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK ; Orthopaedic Office Suite, Clinical Administration, F Level, Queen Alexandra Hospital, Cosham, Portsmouth, Hants PO6 3LY UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Marsland
authors.affiliation: Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Hobbs
authors.affiliation: Department of Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Sauvé
keywords: Distal radioulnar joint; Distal radius fracture; Dorsal cortex screw penetration; Volar locking plate