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Skyline and Carpal Shoot-Through Views Improve Detection of Dorsal Cortex Screw Penetration During Volar Plate Fixation of the Distal Radius: A Cadaveric Analysis.
Kyle Stoops, MD1; Brandon Santoni, PhD1; Nicolette Clark, MS2; Amy Bauer, BS2; Christopher Shoji, BS2; Francisco A. Schwartz Fernandes, MD, MS, MBA2
1Foundation for Orthopaedic Research and Education, Tampa, FL; 2University of South Florida, Tampa, FL

Introduction
The abnormal contour of the dorsal cortex of the distal radius provide difficulties in discerning screw penetration on standard lateral radiographs and may result in soft tissue injuries. The skyline and carpal-shoot through views are additional views described to improve dorsal cortex visibility. This study is a cadaveric analysis evaluating sensitivities in detecting screw protrusion when using skyline and carpal shoot-through views intraoperatively.

Materials and Methods
Seven fresh frozen human cadavers' arms were instrumented with volar locking plate. Following instrumentation, a dorsal dissection of the wrist was performed to detect screw penetration. Protruding screws were replaced with screws of the appropriate length and deemed as baseline. Screws were then sequentially lengthened by 2mm and 4mm. Skyline and carpal shoot through views were obtained at baseline, 2mm, and 4mm. The images were randomized and compiled into an untimed survey asking orthopaedic surgeons to determine if screws were penetrating through the dorsal cortex based on radiographs provided.

Results
Sensitivities for the skyline and carpal shoot-through views were 75% and 86% respectively for 2mm protrusions, and 76% and 89% respectively for 4mm screw protrusions. Specificities were 85% and 84% for the skyline and shoot-though views respectively.

Conclusion
The skyline and carpal shoot-through views are more sensitive at detecting screw protrusions compared to historic controls and should be added to intraoperative protocols and may decrease the incidence of screw protrusion resulting in soft tissue injuries.


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