Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation

Fractures of the distal radius are commonly treated using volar locking plates. Several complications have been associated with this procedure, including extensor tendon irritation and rupture. It has been suggested that prominence of screws past the dorsal cortex may contribute to this complication. This study aimed to determine the ability of the skyline view to demonstrate screws penetrating the dorsal cortex. A volar locking plate was applied to a synthetic forearm model. Lateral, oblique, and skyline views were obtained, with the distal screws both beneath and 1 mm beyond the dorsal cortex. The images were shown to orthopaedic trainees who were asked to decide if screws penetrated the dorsal cortex. Subjects were correct in 83% of cases using the skyline view compared with 77% (p = 0.05, lateral) and 50% (p < 0.01, oblique). This study demonstrates the skyline view of the distal radius could be a useful and accurate addition to routine intraoperative fluoroscopy views.