Evaluation of Intraoperative Skyline View of Wrist to Prevent Dorsal Cortex Penetration in Plating of Distal Radius Fractures

Abstract This study evaluates the efficacy of the intraoperative fluoroscopic skyline view in detecting dorsal cortex screw penetration during surgical fixation of distal radius fractures. Conducted at a tertiary healthcare facility in India, the study included 55 patients aged 18 to 60 years. Intraoperative skyline views, taken with the wrist in supination and flexion, were compared with postoperative CT scans to assess screw tip cortex distance and penetration. The results showed high sensitivity (80.95–93.33%) and specificity (97.06–100%) for detecting screw penetration, with an overall diagnostic accuracy of 94.09%. The study also found excellent inter-rater agreement, indicating strong reliability of the skyline view in real-time intraoperative assessment. Despite some limitations, such as a small sample size and additional radiation exposure, the findings suggest that the skyline view can effectively guide surgeons in ensuring accurate screw placement and of correct size, minimizing the risk of complications like extensor tendon injuries. The study recommends and supports the integration of the skyline view into routine surgical practice for improved outcomes in distal radius fracture fixation. Level of Evidence Level 2, prospective cohort study.