Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures:introduction of the ‘C-Arm Rotational View (CARV)’

Autor: Inge Reininga
Přispěvatelé: Orthopedic Surgery and Sports Medicine, AMS - Ageing & Vitality, AMS - Sports
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: On behalf of the Traumaplatform 3D Consortium 2022, ' Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures : introduction of the ‘C-Arm Rotational View (CARV)’ ', European Journal of Trauma and Emergency Surgery . https://doi.org/10.1007/s00068-022-02038-2
European journal of trauma. Urban und Vogel
European Journal of Trauma and Emergency Surgery. Urban und Vogel
ISSN: 1863-9933
DOI: 10.1007/s00068-022-02038-2
Popis: Purpose Rotational malalignment (≥ 10°) is a frequent pitfall of intramedullary-nailing of tibial shaft fractures. This study aimed to develop an intraoperative fluoroscopy protocol, coined ‘C-Arm Rotational View (CARV)’, to significantly reduce the risk for rotational malalignment and to test its clinical feasibility. Methods A cadaver and clinical feasibility study was conducted to develop the CARV-technique, that included a standardized intraoperative fluoroscopy sequence of predefined landmarks on the uninjured and injured leg in which the rotation of the C-arm was used to verify for rotational alignment. A mid-shaft tibia fracture was simulated in a cadaver and an unlocked intramedullary-nail was inserted. Random degrees of rotational malalignment were applied using a hand-held goniometer via reference wires at the fracture site. Ten surgeons, blinded for the applied rotation, performed rotational corrections according to (1) current clinical practice after single-leg and dual-leg draping, and (2) according to the CARV-protocol. The primary outcome measure was the accuracy of the corrections relative to neutral tibial alignment. The CARV-protocol was tested in a small clinical cohort. Results In total, 180 rotational corrections were performed by 10 surgeons. Correction according to clinical practice using single-leg and dual-leg draping resulted in a median difference of, respectively, 10.0° (IQR 5.0°) and 10.0° (IQR 5.0°) relative to neutral alignment. Single-leg and dual-leg draping resulted in malalignment (≥10°) in, respectively, 67% and 58% of the corrections. Standardized correction using the CARV resulted in a median difference of 5.0° (IQR 5.0°) relative to neutral alignment, with only 12% categorized as malalignment (≥10°). The incidence of rotational malalignment after application of the CARV decreased from 67% and 58% to 12% (p = Conclusion This study introduces an easy-to-use and clinically feasible standardized intraoperative fluoroscopy protocol coined ‘C-arm rotational view (CARV)’ to minimize the risk for rotational malalignment following intramedullary-nailing of tibial shaft fractures.
Databáze: OpenAIRE
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