Does skyline view prevent extensor tendon pathologies during volar plating of distal radius? An ultrasonographic evaluation

OBJECTIVES: This study aims to compare extensor tendon complications of volar plating in distal radius fractures between skyline and lateral views by using postoperative ultrasonography (USG). PATIENTS AND METHODS: Between January 2019 and February 2020, a total of 82 distal radius fractures of 79 patients (39 males, 43 females; median age: 56±12.9 years; range, 23 to 79 years) who were operated with distal four-hole plates and had a follow-up period of at least three months were retrospectively analyzed. During distal radius locking plating, standard lateral fluoroscopic view was used in 36 distal radius fractures and skyline view in addition to lateral view was used in 46 cases. A median of five months later, the protruding screws and extensor compartments were evaluated with USG. The number of screws with dorsal penetration, extent of penetration, and extensor tendon complications were compared between skyline and lateral view groups. RESULTS: In the skyline view group, the rate of dorsal screw penetration was significantly lower than that of the lateral view group (7.3% vs. 14.7%, respectively; p<0.05). Additionally, the rate of extensor tenosynovitis was lower in the skyline view group than in the lateral view group (15% vs. 39%, respectively; p<0.05). No significant difference was seen in the extent of penetration between the groups (1.4 vs. 1.65 mm, respectively; p=0.089). The second compartment had the highest risk for dorsal screw penetration. One case of tendon rupture in the third compartment occurred in the lateral view group. CONCLUSION: The skyline view seems to be an effective method to prevent extensor tendon complications caused by protruding screws.