Arch Hand Microsurg 2019; 24(2): 112-119  
Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures
Kyeong Hoon Lim, Hong Je Kang
Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, korea
Correspondence to: Hong Je Kang
Department of Orthopedic Surgery, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea
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Received: November 6, 2018; Revised: February 15, 2019; Accepted: February 19, 2019; Published online: June 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: The aim of our study was to compare and analyze intraoperative fluoroscopy (skyline view) and mobile cone-beam computed tomography (CBCT) for detecting protruded screws in volar locked plating used for distal radius fractures.
Methods: We carried out a prospective analysis of 35 patients who had undergone both intraoperative fluoroscopy and mobile CBCT. The patients had all undergone volar locking plate fixation for a distal radial fracture at our institution between January and May 2017. Skyline view and mobile CBCT were carried out and protruded screws were replaced. Screw tip cortex distance (STCD) was measured using skyline view and mobile CBCT and compared with each area of the distal radius.
Results: Three screws were found to be protruding after skyline view, and further seven screws were found to be protruding after computed tomography (CT) scan. The mean STCD for each compartment was 3.8±0.6 mm, 3.5±1.8 mm, 2.2±1.3 mm, 3.7±1.6 mm, and 3.9±1.4 mm in the skyline view, respectively, and 3.5±0.7 mm, 0.8±1.6 mm, 0.9±1.1 mm, 2.1±1.6 mm, and 3.7±1.9 mm in the CT scan, respectively (p<0.05). The mean STCD of all screws was 1.2 mm longer in the skyline view than in the CT scan.
Conclusion: The skyline view showed approximately 1-2 mm difference compared to CBCT; therefore, it would be better to insert the screw 2 mm shorter than seen in the skyline view.
Keywords: Distal radius fractures, Skyline view, Cone-beam computed tomography

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