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J Wrist Surg 2025; 14(05): 471-477
DOI: 10.1055/s-0044-1795089
Procedure

Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound

Autoren

  • Jonathan Persitz 

    1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
    3   Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Ahmad Essa

    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada

  • Reut Shor

    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada

  • Norah Faye-Matthies

    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
    3   Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Herb Von Schroeder

    1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
    3   Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Andrea Chan

    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
    3   Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Department of Orthopaedic Surgery, Hospital for Sick Children, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Ryan Paul

    1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
    3   Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract

Introduction

Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and/or into the distal radioulnar joint (DRUJ).

Materials and Methods

Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method.

Results

The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view.

Conclusion

Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required.

Level of Evidence

Therapeutic level V.

Keywords

screw - penetrance - distal radius - volar plating - cadaver

Ethical Approval

This study was approved by the local Institutional Review board.




Publikationsverlauf

Eingereicht: 07. Oktober 2024

Angenommen: 14. Oktober 2024

Artikel online veröffentlicht:
18. November 2024

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