Improving accuracy and confidence in distal radius volar plate screw placement through supplemental radiography: examining specialty, education, and experience levels.

BACKGROUND: The purpose of this study was to assess the extent to which a supplemental radiographic view increases accuracy and confidence ratings when determining screw placement in volar plating of distal radius fractures for evaluators of different specialties and experience levels. METHODS: Thirty-four distal radius fractures treated with volar plate fixation were imaged using standard AP and lateral, and supplemental lateral tilt views. Each case was then evaluated for penetration of distal screw tips into the articular space. Sixty-five physicians then completed a two-phase analysis and survey of these cases. In the first phase, presentation consisted only of AP and lateral views; in the second, the lateral tilt view was added. Participants were asked to determine whether distal screws penetrated the joint and rate their confidence in the determination. Assessments were scored for correctness; changes in accuracy and confidence levels between phases were analyzed using paired t tests. Comparisons between groups were performed by ANOVA. RESULTS: Supplementation increased accuracy and confidence in all position, specialty, and experience groups. Confidence scores were significantly higher following evaluation of three views versus two views. Residents exhibited the greatest improvements in accuracy and confidence. For first-phase (standard view) assessments, accuracy scores were significantly better for attendings with less than 10 years post-fellowship experience than those with more. CONCLUSIONS: A supplemental view of the distal radius combined with AP and lateral views significantly improves the ability of all evaluators, regardless of specialty or training level, to correctly assess placement of fixation screws. The greatest improvements are seen for resident trainees.

Assessing rotational deformity of the little finger.

Excessive scissoring or overlap of fingers can cause discomfort, weaken grip strength, and affect cosmesis. The treatment of little finger fractures is guided by the degree of scissoring or rotational deformity perceived in the digit. The purpose of this study is to assess the variation of little finger scissoring or overlap in the normal population using standard clinical examination. We evaluated 80 uninjured little fingers in 40 normal patients. The digital images of photographed hands, taken in both extension and flexion, were used to evaluate the overlap percentage of the adjacent fingernail as a proxy for rotation of the digits. Paired t tests were used for statistical analysis. The average fingernail overlap was 25% ± 20%, ranging from 0% to 71%. The average overlap on the left hand was significantly less at 21% ± 18% as compared to 30% ± 21% on the right (P < .01). The average variation between hands in individuals was 16% ± 13%.This study confirms that overlap or scissoring of the little finger varies between the hands of a given individual. Our results question the usefulness of assessing rotational deformity of the little finger by checking for overlap and comparing with the contralateral side. This has implications not only in assessing patients for possible surgery, but also in planning and performing surgical reductions of acute fractures and for correction of malunions.