CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(01): 027-033
DOI: 10.1055/s-0041-1728733
Original Article | Artículo Original

Detection of Protruding Screws in the Radiocarpal Joint Using the “Scaphoid Skyline View”

Article in several languages: español | English
1  Hospital del Trabajador, Región Metropolitana, Santiago, Chile
2  Clínica Alemana de Santiago, Región Metropolitana, Santiago, Chile
,
1  Hospital del Trabajador, Región Metropolitana, Santiago, Chile
3  Clínica Las Condes, Región Metropolitana, Santiago, Chile
,
Pamela Vergara
1  Hospital del Trabajador, Región Metropolitana, Santiago, Chile
3  Clínica Las Condes, Región Metropolitana, Santiago, Chile
,
Pedro Ruiz
4  Hospital Puerto Montt Dr. Eduardo Schütz Schroeder, Puerto Montt, Chile
› Author Affiliations

Abstract

Introduction One of the complications of the retrograde percutaneous scaphoid fixation is the protrusion of the screw in the radiocarpal joint due to the limited intraoperative visualization of the proximal pole of the scaphoid with the traditional radiographic views.

Objetive To evaluate the sensitivity of a novel radiographic view (the skyline scaphoid view, SSV) to detect screws protruding in the radiocarpal joint during the retrograde fixation of the scaphoid.

Materials and Methods We studied nine cadaverous fresh frozen wrists. A retrograde cannulated screw was inserted in the scaphoid.

To validate the SSV, 5 wrists were studied, comparing 3 forearm angulations (15°, 30° and 45°) to get the best visualization of the proximal pole and screw.

We compared the ability to identify the protrusion of the screw in the proximal pole of the 30° SSV with that of 5 standard scaphoid radiographic views in 9 wrists. The screw was positioned at the level of the surface of the scaphoid, and was sequentially protruded in 0.5 mm increments, with direct visualization of its tip through a dorsal capsulotomy. After each increment, all views were repeated to determine if they were able to detect screws projecting from the scaphoid.

Results The best visualization of the proximal pole of the scaphoid was found with the 30° SSV. In the comparison of the 30° SSV and the standard views, with the SSV we were able to identify the protrusion of the screws at an average of 0.8 mm, followed by the posterior-anterior view with ulnar deviation and extension at 1.3 mm (p = 0.014), with high precision and interobserver agreement regarding these views.

Conclusion The SSV was the most sensitive view to detect protruding screws in the proximal pole of the scaphoid. Its routine use could avoid complications during osteosynthesis.



Publication History

Received: 27 July 2020

Accepted: 21 January 2021

Publication Date:
02 June 2021 (online)

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