Distal radius fluoroscopic skyline view: extension-supination versus flexion-supination

Area of Science:

• Orthopedic Surgery
• Radiology
• Anatomy

Background:

• Distal radius fractures are common injuries requiring surgical intervention.
• Accurate assessment of fracture reduction and fixation is crucial for optimal patient outcomes.
• Standard fluoroscopic views may have limitations in visualizing critical anatomical landmarks.

Purpose of the Study:

• To compare the efficacy of two vertical fluoroscopic wrist views for visualizing anatomical landmarks after distal radius fracture fixation.
• To determine the optimal fluoroscopic view for assessing fracture reduction quality, distal radioulnar joint integrity, and screw length.
• To evaluate the recognition rate and concordance of key anatomical landmarks (SDLR) between the two views.

Main Methods:

• A case series of 50 patients with distal radius fractures undergoing open reduction and internal fixation with a volar locking plate.
• Two fluoroscopic views were obtained: wrist extension and supination (ES) and wrist flexion and supination (FS).
• Ten observers assessed the visualization of four anatomical landmarks (radial styloid, dorsal radius cortex, Lister's tubercle, distal radioulnar joint) on 100 skyline views.

Main Results:

• The ES view achieved a 78% recognition rate for the four anatomical landmarks, compared to 66% for the FS view (p < 0.001).
• The concordance rate for landmark recognition between observers was mediocre (κ = 0.411).
• The ES view demonstrated superior visualization of the SDLR landmarks.

Conclusions:

• The vertical fluoroscopic skyline view in wrist extension and supination is recommended for assessing distal radius fracture reduction quality, the distal radioulnar joint, and screw length.
• This view aids in evaluating the outcomes of open reduction and internal fixation with volar locking plates.
• Improved visualization of anatomical landmarks can lead to better surgical decision-making and patient outcomes.