title: Comparison of intraoperative flat panel imaging and postoperative plain radiography for the detection of intraarticular screw displacement in volar distal radius plate ostheosynthesis.
abstract: OBJECTIVE
  To investigate if intraoperative 3D flat panel imaging improves the detection of radiocarpal intraarticular screw misplacement (RCSM) in comparison to standard postoperative x-ray.
  
  
  METHODS
  In a study on cadaver specimens, we evaluated the sensitivity and specificity to detect RCSM using X-ray, intraoperative 3D-fluoroscopy as well as the digital volume tomography. The gold standard reference was computed tomography.
  
  
  RESULTS
  Sensitivity for the detection of RCSM for X-ray was 58% and specificity 88%. For DVT, the sensitivity to detect RCSM was 88% and the specificity 53%. For 3D-fluoroscopy, the sensitivity for RCSM was 68% and specificity 95%. When combining the methods, the best performance was found, when combining the two intraoperative imaging methods, with a resulting sensitivity of 88% and a specificity of 73%.
  
  
  CONCLUSIONS
  Intraoperative 3D fluoroscopy and digital volume tomography appear to be at least as sensitive and specific to detect RCSM than the regular postoperative radiography in two planes. However, especially discrete screw misplacements can be missed with either method.
  
  
  METHODS
  Level IV. Diagnostic device study.
authors.affiliation: University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of radiology, Uniklinik Köln, Köln, Germany. Electronic address: Jan.Borggrefe@uk-koeln.de.
authors.forename: J
authors.initials: J
authors.lastname: Borggrefe
authors.affiliation: University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of nuclear medicine, university-Clinics Münster, Münster, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bolte
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Worms
authors.affiliation: Saint-Vincenz hospital, Paderborn, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Mahlke
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Seekamp
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Menzdorf
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Varoga
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Weuster
authors.affiliation: Department of neurology, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Zorenkov
authors.affiliation: Department of anatomy, Christian-Albrecht-aniversity, Kiel, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wedel
authors.affiliation: Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Lippross
mesh_terms: D001860:Bone Plates; D001863:Bone Screws / Q000009:adverse effects*; D002102:Cadaver; D054893:Cone-Beam Computed Tomography; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D011184:Postoperative Period; D011884:Radius / Q000601:surgery; D011885:Radius Fractures / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Flat panel detector; Intraarticular screw; Intraoperative fluoroscopy; Radius fracture; Screw misplacement