Arch Hand Microsurg.  2019 Jun;24(2):112-119. 10.12790/ahm.2019.24.2.112.

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

• Lim KH
• Kang HJ

• KMID: 2448044
• DOI: http://doi.org/10.12790/ahm.2019.24.2.112

Abstract

PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.

Keyword

Distal radius fractures; Skyline view; Cone-beam computed tomography

MeSH Terms

Cone-Beam Computed Tomography
Fluoroscopy
Humans
Prospective Studies
Radius Fractures*
Radius*
Tomography, X-Ray Computed

Figure

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  Fig. 1 (A) Skyline view of the distal radius. (B) Skyline view was taken on the C-arm with wrist flexion of 75°.

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  Fig. 2 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.

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  Fig. 3 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.

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  Fig. 4 (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.

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  Fig. 5 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.

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