In fractures with an intact dorsal cortex, standard depth gauges will likely produce appropriate screw length measurements. However, even in this situation, and based on the results reported by Wall and colleagues,12 subtraction of 1 to 2 mm may prove prudent. In cases in which the dorsal cortex is comminuted and screw estimates based on fluoroscopy are used, the lateral image may provide estimates that lead to screw prominence. A 45° supinated view should be used to check screw length for the radial side, the column most at risk. However, comminution may also obscure this view. We cannot comment on that, as the present study did not create comminuted fractures of the distal radius. In addition, the ulnar column posed a lesser but real risk of screw prominence, which must also be accounted for, and typically is not appreciated with alternate views.
Last, use of live fluoroscopy instead of standard anteroposterior and lateral views may prove valuable in assessing hardware placement and screw length in the setting of a comminuted distal radius fracture. Through use of live fluoroscopy, prominent screws, especially those on the radial side, may be identified, and potential tendon injury may be avoided. Keeping in mind the shape of the dorsal aspect of the distal radius should assist surgeons in preventing screw prominence dorsally and limit complications.