Comparing Dorsal Tangential and Lateral Views of theWrist for Detecting Dorsal Screw Penetration after Volar Platingof Distal Radius Fractures

The dorsal tangential (DT) view has been shown to improve the detection of dorsal screw perforation during volar distalradius fracture fixation. Here we performed a cadaveric imaging survey study to evaluate if the DT view was uniformly beneficial forall screws.Methods. Standardized placement of fixed-angle volar distal radius plates was performed on two cadavers. Fluoroscopicimages depicting variable screw perforation of each of the four screw holes on the plate were generated. A 46-image survey wasdistributed at a large academic medical center. Respondents were asked to answer if the screw was perforating through the dorsalcortex in each image. Statistical analysis was performed using Fisher’s exact test. A𝑝value<.05 was considered significant.Results.The DT view offered a significantly more reliable determination of dorsal screw penetration than traditional lateral imaging for theradial-most screw at all degrees of perforation and the middle two screws at 2 mm of perforation. Residents and attendings hadmore accurate screw readings overall using the DT view.Conclusions. The DT view is superior to traditional lateral imaging in thedetection of small amounts of dorsal perforation of the radial-most three screws of a fixed-angle volar plate.