{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T23:10:14Z","timestamp":1758669014935,"version":"3.44.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and\/or into the distal radioulnar joint (DRUJ).<\/jats:p><jats:p>Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method.<\/jats:p><jats:p>The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view.<\/jats:p><jats:p>Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required.<\/jats:p><jats:p>Therapeutic level V.<\/jats:p>","DOI":"10.1055\/s-0044-1795089","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T18:50:12Z","timestamp":1731955812000},"page":"471-477","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Detection of Screw Penetration Following Volar Plating of the Distal Radius: A Cadaveric Study Comparing Fluoroscopic Imaging and Ultrasound"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7886-8369","authenticated-orcid":false,"given":"Jonathan","family":"Persitz","sequence":"additional","affiliation":[{"name":"Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Essa","sequence":"additional","affiliation":[{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reut","family":"Shor","sequence":"additional","affiliation":[{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norah","family":"Faye-Matthies","sequence":"additional","affiliation":[{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herb Von","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Chan","sequence":"additional","affiliation":[{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Hospital for Sick Children, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Paul","sequence":"additional","affiliation":[{"name":"Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"},{"name":"Department of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/BOT.0b013e318059b993","article-title":"Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate","volume":"21","author":"R Arora","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1016\/j.jhsa.2011.07.020","article-title":"The dorsal horizon view: detecting screw protrusion at the distal radius","volume":"36","author":"S J Joseph","year":"2011","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1007\/s11552-014-9607-0","article-title":"Volar locking plate fixation of distal radius fractures: use of an intra-operative \u2018carpal shoot through\u2019 view to identify dorsal compartment and distal radioulnar joint screw penetration","volume":"9","author":"D Marsland","year":"2014","journal-title":"Hand (N Y)"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jor.25341","article-title":"Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius","volume":"41","author":"J M Yang","year":"2023","journal-title":"J Orthop Res"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.aott.2017.10.004","article-title":"Comparison of ultrasound and dorsal horizon radiographic view for the detection of dorsal screw penetration","volume":"51","author":"Y Gurbuz","year":"2017","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.otsr.2017.04.001","article-title":"Detection of penetration of the dorsal cortex by epiphyseal screws of distal radius volar plates: Anatomical study comparing ultrasound and fluoroscopy","volume":"103","author":"P Vernet","year":"2017","journal-title":"Orthop Traumatol Surg Res"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1002\/jum.14241","article-title":"Distal forearm fracture open reduction-internal fixation: sonographic detection of hardware malalignment and associated tendon injuries missed by radiography","volume":"36","author":"T A Morgan","year":"2017","journal-title":"J Ultrasound Med"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1055\/s-0039-1681026","article-title":"Volar plating: imaging modalities for the detection of screw penetration","volume":"8","author":"M Bergsma","year":"2019","journal-title":"J Wrist Surg"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jhsa.2003.09.004","article-title":"Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation","volume":"29","author":"M I Boyer","year":"2004","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref10","first-page":"714","article-title":"Complications of volar plating of distal radius fractures","volume":"73","author":"M Rampoldi","year":"2007","journal-title":"Acta Orthop Belg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1007\/s11552-010-9316-2","article-title":"Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating","volume":"6","author":"K Ozer","year":"2011","journal-title":"Hand (N Y)"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/1558944716677336","article-title":"Sensitivity and specificity of skyline and carpal shoot-through fluoroscopic views of volar plate fixation of the distal radius: a cadaveric investigation of dorsal cortex screw penetration","volume":"12","author":"T K Stoops","year":"2017","journal-title":"Hand (N Y)"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s11552-014-9616-z","article-title":"Intraoperative evaluation of dorsal screw prominence after polyaxial volar plate fixation of distal radius fractures utilizing the Hoya view: a cadaveric study","volume":"9","author":"D Dolce","year":"2014","journal-title":"Hand (N Y)"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1402517","DOI":"10.1155\/2017\/1402517","article-title":"Comparing dorsal tangential and lateral views of the wrist for detecting dorsal screw penetration after volar plating of distal radius fractures","volume":"2017","author":"J M Giugale","year":"2017","journal-title":"Adv Orthop"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"e408","DOI":"10.1097\/BOT.0000000000000361","article-title":"Dorsal screw penetration with the use of volar plating of distal radius fractures: how can you best detect?","volume":"29","author":"B W Hill","year":"2015","journal-title":"J Orthop Trauma"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1055\/s-0034-1394132","article-title":"The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures","volume":"3","author":"L Vaiss","year":"2014","journal-title":"J Wrist Surg"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/1460408616664550","article-title":"Detecting dorsal screw penetration following volar plate fixation of the distal radius\u2014a validation study in a saw bone model","volume":"19","author":"W E Poole","year":"2017","journal-title":"Trauma"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/1753193410392869","article-title":"Screw prominences related to palmar locking plating of distal radius","volume":"36","author":"T S S\u00fcg\u00fcn","year":"2011","journal-title":"J Hand Surg Eur Vol"},{"issue":"01","key":"ref19","first-page":"36","article-title":"Ultrasound imaging improves identification of prominent hardware in the surgical treatment of distal radius fractures: a cadaveric and prospective clinical study","volume":"5","author":"J D Watchmaker","year":"2016","journal-title":"J Wrist Surg"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jhsa.2008.10.002","article-title":"Use of fluoroscopy in determining screw overshoot in the dorsal distal radius: a cadaveric study","volume":"34","author":"A D Thomas","year":"2009","journal-title":"J Hand Surg Am"}],"container-title":["Journal of Wrist 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