Authors: Darren Grimwood Jane HarveyLloyd
Publish Date: 2016/08/25
Volume: 26, Issue: 8, Pages: 867-876
Abstract
Intramedullary nailing is the standard surgical treatment for middiaphyseal fractures of long bones however it is also a high radiation dose procedure Distal locking is regularly cited as a demanding element of the procedure and there remains a reliance on Xray fluoroscopy to locate the distal holes A recently developed electromagnetic navigation EMN system allows radiationfree distal locking with a virtual onscreen imageConsecutive patients with middiaphyseal fractures of the tibia and femur treatable with intramedullary nails were prospectively enrolled during a 9month period The sample consisted of 29 individuals 19 under fluoroscopic guidance and 10 utilising EMN Participants were allocated depending on the type of intramedullary nail used and surgeon’s preference These were further divided into tibial and femoral subcategories relative to the fracture siteEMN reduced fluoroscopy time by 49 p = 0038 and 28 s during tibial and femoral nailings respectively Radiation dose was reduced by 18 cGy/cm2 p = 0046 during tibial and 181 cGy/cm2 during femoral nailings when utilising EMN Operative duration was 11 min slower during tibial nailings using EMN but 38 min faster in respect of femoral nailingsThis study has evidenced statistically significant reductions in both fluoroscopy time and radiation dose when using EMN for the distal locking of intramedullary nails It is expected that overall operative duration would also decrease in line with similar studies with increased usage and a larger sample
Keywords: