Abstract
Background
The irregular nature of the dorsal surface of the distal radius makes it difficult to detect prominent screws with volar plate fixation for distal radius fractures using standard fluoroscopic images. This study evaluates the accuracy of a new radiographic method, the Hoya view, for the assessment of dorsal cortical screw penetration with volar plate fixation.
Methods
Eight cadaveric upper extremities underwent application of a volar distal radius plate with polyaxial locking screws placed distally. Utilizing a mini C-arm, lateral and Hoya views were obtained with notation of any dorsal cortical screw prominence. Dissection of the cadavers was then performed for direct visualization of screw prominence. The screws were then exchanged sequentially for screws 2-mm longer than their initial measurements with repeated imaging and direct visualization.
Results
The Hoya view revealed that 9.4 % of the screws penetrated the dorsal cortex with an average screw prominence of 1.08 mm (range 0.5–2 mm). None of the six prominent screws were detected with lateral views. With the Hoya view, six of six prominent screws were identified. With locking screws exchanged for screws 2-mm longer, 76.6 % of the screws had violated the dorsal cortex; of these, 24.5 % were detected with lateral imaging versus 100 % with the Hoya view.
Conclusions
This study supports the intraoperative use of the Hoya view to evaluate screw length and dorsal cortical screw penetration in volar plate fixation of distal radius fractures. However, this view may be difficult to obtain in patients with limitations in elbow or shoulder range of motion.
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Acknowledgments
We would like to thank Kenneth Rogers, Ph.D. for assistance with the statistical analysis. We are also grateful to Clark Baumbusch, M.D., Konstantinos Marinos Triantafillou, M.D., and Benjamin Baronne, M.D. whose hard work and diligence allowed this project to move forward.
Conflict of Interest
Donald Dolce declares that he has no conflict of interest.
David Goodwin declares that he has no conflict of interest.
Meryl Ludwig declares that she has no conflict of interest.
Scott Edwards has received a speaker honorarium from Medartis.
Cadaveric specimens and distal radius volar plating systems were provided through a grant from the Medartis Corporation.
No further funds or benefits were received or will be received related directly or indirectly to the subject of this article.
Statement of Human and Animal Rights
All procedures followed as part of this study are in accordance with ethical standards of the Institutional Review Board and with the Helsinki Declaration of 1975, revised in 2000.
Statement of Informed Consent
Informed consent was not obtained as this is a cadaveric study. Figure 1 does include imaging of a patient; however, no identifiable features are present and patient confidentiality is maintained.
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Dolce, D., Goodwin, D., Ludwig, M. et al. Intraoperative evaluation of dorsal screw prominence after polyaxial volar plate fixation of distal radius fractures utilizing the Hoya view: a cadaveric study. HAND 9, 511–515 (2014). https://doi.org/10.1007/s11552-014-9616-z
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DOI: https://doi.org/10.1007/s11552-014-9616-z