Document Detail

The Insertion of IMN Locking Screws without Fluoroscopy: A Faster and Safer Technique.
MedLine Citation:
PMID:  23287748     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: This study was designed to compare the accuracy, time, and radiation exposure during the insertion of intramedullary nail (IMN) locking screws using either standard fluoroscopic assistance (FA), or an electromagnetic (EM) based navigational system without fluoroscopy. DESIGN:: Prospective. SETTING:: Level I academic trauma center. METHODS:: Patients were divided into two groups: Group 1 (FA), consisted of standard free-hand fluoroscopically assisted insertion of locking screws (OEC 9900, G.E. HealthCare, Waukesha, WI, USA), while Group 2 (EM) consisted of EM navigationally assisted insertion without fluoroscopy (SureShot®, Smith & Nephew, Memphis, TN, USA). Technician arrival time, set up time, screw insertion time (sec), fluoroscopy time (sec), radiation exposure (mrads) and accuracy (hit or miss) were recorded for each screw. For Group 1, the set-up was recorded as the time and radiation required to obtain "perfect circles" before insertion; for Group 2, the set-up time was recorded as the time required to set up the navigational EM unit. Data collected regarding screw insertion was then compared using standard analysis of variance. RESULTS:: 41 locking screws were inserted in Group 1, while 60 screws were inserted in Group 2. Accuracy was 100% for both groups. For Group 1, mean technician wait time was 77 seconds, plus a mean "perfect circle" set-up time of 105 seconds (9.2 mrads and 10 seconds of fluoroscopy). Mean set-up time for Group 2 was 94 seconds (no fluoroscopy). Mean insertion time was 342 seconds/screw for Group 1 (32.9 mrads and 18 seconds of fluoroscopy), compared with 234 seconds/screw for Group 2 (no fluoroscopy). These differences were statistically significant (p=0.006). CONCLUSION:: The use of EM navigation (SureShot®, Smith & Nephew, Memphis, Tenn, USA) for the insertion of IMN locking screws demonstrated accuracy similar to conventional fluoroscopic guided insertion. However, EM guided locking screw insertion resulted in a significantly shorter total procedural time, and completely eliminated radiation exposure.
Daniel S Chan; Richard B Burris; Murat Erdogan; H Claude Sagi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-2
Journal Detail:
Title:  Journal of orthopaedic trauma     Volume:  -     ISSN:  1531-2291     ISO Abbreviation:  J Orthop Trauma     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807705     Medline TA:  J Orthop Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, Florida *University of South Florida, Tampa, Florida **Ondokuz Mayis University, Turkey.
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