Abstract
PURPOSE: Dorsal screw tip protrusion (DSTP) with extensor tendon injury is a well-known complication after volar plating of the distal radius. Specific fluoroscopic views such as the dorsal tangential view (DTV) and the radial groove view (RGV) have been recommended to detect DSTP. The aim of this study was to investigate the accuracy of these views before and after standardized teaching of the involved surgeons. METHODS: All adult patients treated with volar plating of the distal radius between 10/2019 and 09/2020 were included. All involved surgeons were instructed on how to perform accurate DTV and RGV. Patients from an earlier period (07/2018-09/2019) before teaching served as controls. The impact of teaching was assessed. Intraoperative detection of DSTP based on fluoroscopy was documented. DTV and RGV were further evaluated as a set of fluoroscopic investigations and not as individual views. The accuracy of DTV and RGV to detect DSTP was compared with that of postoperative ultrasound. RESULTS: A total of 124 patients were included in the study group and compared with the control group (n = 125). Interobserver agreement for the image accuracy was 97% for DTV and 98% for RGV, respectively. Correct images were observed for DTV in 81% after standardized teaching versus 58% for the control group and 81% versus 53% for RGV, respectively (P < .001). Intraoperative fluoroscopy detected 24 DSTP in 571 evaluated screws (4.2%) in the study group, most of them affecting the second (n = 11) and fourth (n = 10) extensor compartments. Sensitivity to detect DSTP was 85.7% for DTV and RGV combined. Postoperative ultrasound revealed four DSTP (0.8-1.2 mm; 0.7%) in four patients (3.2%). CONCLUSIONS: Standardized teaching leads to a significant improvement of appropriate views. DTV and RGV are reliable tools to detect DSTP. However, some minor dorsal cortex penetrations may be missed. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IIb.