A comparative study about ionizing radiation emitted during radiological "skyline" view of the wrist in pronation versus supination.

The dorsal tangential view to the distal radius or "skyline," used to control the length of the screws for the ORIF with volar plates, is carried out in supination (fluoroscope vertical) or in pronation (fluoroscope horizontal). The purpose of this study was to compare the dose of ionizing radiation emitted during a "skyline" view in supination versus pronation. A "skyline" was performed on 14 fresh cadaveric wrists. In group 1, the fluoroscope was positioned vertically and the wrist was held in supination. In group 2, the fluoroscope was positioned horizontally and the wrist held in pronation. The average dose of ionizing radiation was 0.9286 cGy/cm(2) (group 1) and 0.8751 cGy/cm(2) (group 2). The difference was not statistically significant. Overall, the emitted dose for the "skyline" is negligible compared to that of a standard wrist radiography with no difference between the vertical and horizontal positioning. Peroperatively, the vertical "skyline" seems easier to setup, less time consuming and less prone to asepsis faults.

Functional and socioprofessional outcome of surgery for Volkmann's contracture.

OBJECTIVES: Volkmann's ischemic contracture is rare and surgical treatment remains a challenge. The goal of treatment is to obtain permanent recovery of joint range of motion and strength. The goal of this study was to evaluate the functional and socioprofessional outcome of surgical treatment of Volkmann's ischemic contracture. METHODS: This retrospective study was performed in two centers with one surgeon. Seven patients were included; mean age 23.6 years old. The Quick-Dash score, Patient Rated Wrist Questionnaire (PRWE) scores were obtained. Grip strength was compared to the contralateral side. Satisfaction was evaluated by the question: would you have surgery again? The surgical technique included 7 muscle slide procedures. RESULTS: Wrist and finger range of motion was good at least 6.1years in all cases according to the system by Buck-Gramcko. Grip strength on the operated side was 72.3% of the contralateral side. The mean PRWE was 14.64/100, mean QUICK-DASH score was 7.9/100. Patients returned to their professional activities in all cases. Patients who were questioned were all satisfied with surgery. CONCLUSIONS: Once the contracture is established in Volkmann's contracture Page-Scaglieti-Gosset muscle slide procedure can be used with good results allowing a return to socioprofessional activities. LEVEL OF EVIDENCE: IV, retrospective study.

The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures.

Background Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence IV.