Comparing Dorsal Tangential and Lateral Views of the Wrist for Detecting Dorsal Screw Penetration after Volar Plating of Distal Radius Fractures

BACKGROUND: The dorsal tangential (DT) view has been shown to improve the detection of dorsal screw perforation during volar distal radius fracture fixation. Here we performed a cadaveric imaging survey study to evaluate if the DT view was uniformly beneficial for all screws. METHODS: Standardized placement of fixed-angle volar distal radius plates was performed on two cadavers. Fluoroscopic images depicting variable screw perforation of each of the four screw holes on the plate were generated. A 46-image survey was distributed at a large academic medical center. Respondents were asked to answer if the screw was perforating through the dorsal cortex in each image. Statistical analysis was performed using Fisher's exact test. A p value < .05 was considered significant. RESULTS: The DT view offered a significantly more reliable determination of dorsal screw penetration than traditional lateral imaging for the radial-most screw at all degrees of perforation and the middle two screws at 2 mm of perforation. Residents and attendings had more accurate screw readings overall using the DT view. CONCLUSIONS: The DT view is superior to traditional lateral imaging in the detection of small amounts of dorsal perforation of the radial-most three screws of a fixed-angle volar plate.