Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures

Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures

Abstract

Purpose

Methods

Results

Conclusion

Figures and Tables

(A) Skyline view of the distal radius. (B) Skyline view was taken on the C-arm with wrist flexion of 75°.

Mobile cone-beam computed tomography (CBCT) (Phion™; NanoFocusRay Co., Ltd.) available in the operating room. Mobile CBCT has its own shielding structure so that it prevents radiation exposure to other part of the body.

The distance between the tip of the screw tip and dorsal cortex (STCD) was measured and compared for each compartment. (A) Skyline view. (B) Mobile cone-beam computed tomography. Up down arrows: STCD.

(A) Extensor compartment of radial dorsal cortex. (B) The dorsal cortex of radius was divided into five areas (1, 2, 3, 4, 5) and mean screw tip cortex distance was compared for each compartment.

Comparison of screw tip cortex distance measured by skyline view and mobile cone-beam computed tomography (CBCT). The screw in the circle is not protruded in skyline view, whereas it is protruded in the mobile CBCT. (A) Skyline view. (B) Mobile CBCT.

The number of screws replaced and detected protrusion

STCD measured by skyline view and mobile CBCT (mm)

ACKNOWLEDGEMENTS

Notes

References

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Kyeong Hoon Lim; Hong Je Kang

doi:10.12790/ahm.2019.24.2.112

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Lim and Kang: Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures

Hand

Archives of Hand and Microsurgery 2019; 24(2): 112-119.

Published online: 30 May 2019

DOI: https://doi.org/10.12790/ahm.2019.24.2.112

Kyeong Hoon Lim, Hong Je Kang

Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

Corresponding author: Hong Je Kang. Department of Orthopedic Surgery, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea. TEL: +82-63-859-1360, FAX: +82-63-852-9329, kanghongje@hanmail.net

Received 6 November 2018 Revised 15 February 2019 Accepted 19 February 2019

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of our study was to compare and analyze intraoperative fluoroscopy (skyline view) and mobile cone-beam computed tomography (CBCT) for detecting protruded screws in volar locked plating used for distal radius fractures.

We carried out a prospective analysis of 35 patients who had undergone both intraoperative fluoroscopy and mobile CBCT. The patients had all undergone volar locking plate fixation for a distal radial fracture at our institution between January and May 2017. Skyline view and mobile CBCT were carried out and protruded screws were replaced. Screw tip cortex distance (STCD) was measured using skyline view and mobile CBCT and compared with each area of the distal radius.

Three screws were found to be protruding after skyline view, and further seven screws were found to be protruding after computed tomography (CT) scan. The mean STCD for each compartment was 3.8±0.6 mm, 3.5±1.8 mm, 2.2±1.3 mm, 3.7±1.6 mm, and 3.9±1.4 mm in the skyline view, respectively, and 3.5±0.7 mm, 0.8±1.6 mm, 0.9±1.1 mm, 2.1±1.6 mm, and 3.7±1.9 mm in the CT scan, respectively (p<0.05). The mean STCD of all screws was 1.2 mm longer in the skyline view than in the CT scan.

The skyline view showed approximately 1-2 mm difference compared to CBCT; therefore, it would be better to insert the screw 2 mm shorter than seen in the skyline view.

Keywords: Distal radius fractures, Skyline view, Cone-beam computed tomography

CBCT: cone-beam computed tomography.

	Area					Total
	1	2	3	4	5	Total
Skyline view	3.8±0.6	3.5±1.8	2.2±1.3	3.7±1.6	3.9±1.4	3.4±1.5
CBCT	3.5±0.7	0.8±1.6	0.9±1.1	2.1±1.6	3.7±1.9	2.2±1.8
Difference	0.3±0.7	2.7±0.2	1.3±0.2	1.6±0.4	0.3±1.2	1.2±0.7
p-value	0.007	<0.001	<0.001	<0.001	0.193	<0.001

Values are presented as mean±standard deviation.

STCD: screw tip cortex distance, CBCT: cone-beam computed tomography.

This paper was supported by Wonkwang University in 2019.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

No. of screws inserted

No. of protruded screws detected with skyline view

No. of protruded screws detected with CBCT

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