ArticleJournal of orthopaedic surgery and research2025
Skyline view versus intraoperative 3D fluoroscopy for dorsal screw protrusion identification following volar plating in the treatment of distal radial fracture.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Role of Intraoperative 2D and 3D Fluoroscopy in Identifying Malposition of Screws in Surgical Fixation of Intra-articular Distal Radius Fractures in Comparison to Post-operative Computed Tomography.Journal of orthopaedic case reports · 2026Article
- Adults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication Prevention.Journal of hand surgery global online · 2026Article
- A Comparison of Intraoperative 3D and Conventional 2D Fluoroscopy to Detect Screw Misplacement in Volar Plate Osteosynthesis of the Distal Radius.Journal of clinical medicine · 2025Article
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6 authors.
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Abstract
backgroundDorsal screw protrusion can lead to complications such as extensor pollicis longus (EPL) tear or rupture after volar locking plate (VLP) fixation. Previous studies displayed that intraoperative 3D fluoroscopy and skyline view had similar diagnostic accuracy. This study investigated the efficacy of intraoperative 3D fluoroscopy compared to skyline view for detecting dorsal cortex screw protrusion in VLP procedures for unstable intra-articular distal radius fractures (DRF). We used postoperative computed tomography (CT) to assess the efficacy and addressed the limitations of previous methods in evaluating screw penetration accurately.
methodsWe utilized the ICUC database, a prospective cohort of patients with surgically treated DRF, to collect cases with available images, including skyline views, intraoperative 3D fluoroscopy, and postoperative CT scans. The postoperative CT confirmed whether the screw protruded through the dorsal cortex. The interrater reliability was assessed using Cohen's Kappa, and a diagnostic test was utilized to compare the two intraoperative imaging modalities.
resultsTwenty-one unstable DRFs were included in the study. The agreement between skyline view and postoperative CT was moderate agreement, with a kappa value of 0.481 (95% CI: 0.297-0.652, N = 84), identifying 10 uncertain, 56 shorter screws, and 18 screw penetrations. Intraoperative 3D fluoroscopy demonstrated almost perfect agreement with postoperative CT, with a kappa of 0.839 (95% CI: 0.703-0.975, N = 84), identifying 62 shorter screws and 22 screw penetrations. The sensitivity and specificity of intraoperative 3D fluoroscopy in detecting dorsal screw protrusion were 81.8% and 98.4%, respectively, while the skyline view's sensitivity and specificity were 72.2% and 90.9%.
conclusion3D fluoroscopy offers an almost perfect evaluation, whereas the skyline views provide only moderate agreement. 3D fluoroscopy could reduce cumulative radiation exposure of surgeon and patient compared to skyline view. Clinically, 3D fluoroscopy would be beneficial for surgeons to evaluate dorsal screw protrusion precisely and safely.
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