Skip to main content

Advertisement

SpringerLink
Log in

Comparison of intraoperative radiation exposure with and without use of distal targeting device: a randomized control study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

When locking intramedullary nails, inserting the distal interlocking screw accurately and quickly with less radiation exposure is very important. The purpose of this randomized control study was to compare radiation exposure and accuracy of distal locking screws between free-hand fluoroscopic guidance and the use of a distal targeting system (DTS).

Materials and methods

Inclusion criteria of this study were patients older than 60 years who need an intramedullary nailing due to unstable intertrochanteric and subtrochanteric fracture. The primary outcome was the attempt numbers of image intensifier during the insertion of distal locking screws. Secondary outcomes were operative time and angles between distal locking screws and nail.

Results

A total of 36 patients participated in the study. Eighteen patients using free-hand fluoroscopic guidance were assigned to Group I while 18 patients using DTS were assigned to Group II. The number of attempts of image intensifier during distal screw insertion (57.3 ± 31.42 vs. 11.5 ± 7.41, p < 0.001), ratio of attempt number for distal screws to the total attempts (0.33 ± 0.21 vs. 0.12 ± 0.08, p = 0.001), the number of hand exposure to image intensifier directly (75.0 ± 29.55 vs. 13.5 ± 19.07, p < 0.001), and the time of radiation exposure during distal screws insertion (42.57 ± 2.42 s vs. 12.72 ± 8.10 s, p < 0.001) were significantly lower in Group II compared to those in Group I. And, operation time (96.3 min ± 18.94 vs. 76.1 min ± 14.10, p < 0.001) was also statistically significantly lower in Group II. Both distal locking screws were significantly closer to perpendicular direction to the nail in Group II.

Conclusion

The attempt number of image intensifier during the insertion of two distal locking screws was significantly reduced with DTS compared with that with free hand fluoroscopic guidance. Angle between distal locking screws and nail was also more accurate using DTS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Choi YJ, Oh HJ, Kim DJ et al (2012) The prevalence of osteoporosis in Korean adults aged 50 years or older and the higher diagnosis rates in women who were beneficiaries of a national screening program: The Korea National Health and Nutrition Examination Survey 2008–2009. J Bone Miner Res 27:1879–1886. https://doi.org/10.1002/jbmr.1635

    Article  PubMed  Google Scholar 

  2. Shin CS, Choi HJ, Kim MJ et al (2010) Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone 47:378–387. https://doi.org/10.1016/j.bone.2010.03.017

    Article  PubMed  Google Scholar 

  3. Lee Y-K, Yoon B-H, Koo K-H (2013) Epidemiology of osteoporosis and osteoporotic fractures in South Korea. Endocrinol Metab (Seoul) 28:90–93. https://doi.org/10.3803/EnM.2013.28.2.90

    Article  Google Scholar 

  4. Ahn S-K, Kam S, Chun B-Y (2014) Incidence of and factors for self-reported fragility fractures among middle-aged and elderly women in rural Korea: an 11-year follow-up study. J Prev Med Public Health 47:289–297. https://doi.org/10.3961/jpmph.14.020

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hong W, Cheng Q, Zhu X et al (2015) Prevalence of sarcopenia and its relationship with sites of fragility fractures in elderly chinese men and women. PLoS One 10:e0138102. https://doi.org/10.1371/journal.pone.0138102

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ha Y-C, Park Y-G, Nam KW, Kim S-R (2015) Trend in hip fracture incidence and mortality in Korea: a prospective cohort study from 2002 to 2011. J Korean Med Sci 30:483–488. https://doi.org/10.3346/jkms.2015.30.4.483

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kang H-Y, Yang K, Kim YN et al (2010) Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health 10:230. https://doi.org/10.1186/1471-2458-10-230

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim S-R, Ha Y-C, Kim J-R et al (2010) Incidence of hip fractures in Jeju Island, South Korea: a prospective study (2002–2006). Clin Orthop Surg 2:64–68. https://doi.org/10.4055/cios.2010.2.2.64

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park Y-G, Jang S, Ha Y-C (2014) Incidence, morbidity and mortality in patients older than 50 years with second hip fracture in a jeju cohort study. Hip Pelvis 26:250–255. https://doi.org/10.5371/hp.2014.26.4.250

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wu X, Yang M, Wu L, Niu W (2015) A biomechanical comparison of two intramedullary implants for subtrochanteric fracture in two healing stages: a finite element analysis. Appl Bionics Biomech 2015:1. https://doi.org/10.1155/2015/475261

    Article  CAS  Google Scholar 

  11. Kummer FJ, Olsson O, Pearlman CA et al (1998) Intramedullary versus extramedullar fixation of subtrochanteric fractures: a biomechanical study. Acta Orthop Scand 69:580–584. https://doi.org/10.3109/17453679808999259

    Article  CAS  PubMed  Google Scholar 

  12. Hsu W-E, Yu C-H, Chang C-J, et al (2018) C-arm image-based surgical path planning method for distal locking of intramedullary nails. In: applied bionics and biomechanics. https://www.hindawi.com/journals/abb/2018/4530386/. Accessed 2 Oct 2018

    Article  Google Scholar 

  13. Tasbas BA, Yagmurlu MF, Bayrakci K et al (2003) Which one is at risk in intraoperative fluoroscopy? Assistant surgeon or orthopaedic surgeon? Arch Orthop Trauma Surg 123:242–244. https://doi.org/10.1007/s00402-003-0516-x

    Article  PubMed  Google Scholar 

  14. O’Rourke PJ, Crerand S, Harrington P, et al (1996) Risks of radiation exposure to orthopaedic surgeons. J R Coll Surg Edinb 41:40–43

    PubMed  Google Scholar 

  15. Kaplan DJ, Patel JN, Liporace FA, Yoon RS (2016) Intraoperative radiation safety in orthopaedics: a review of the ALARA (As low as reasonably achievable) principle. Patient Saf Surg. https://doi.org/10.1186/s13037-016-0115-8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anastopoulos G, Ntagiopoulos PG, Chissas D et al (2008) Evaluation of the stryker S2 IM nail distal targeting device for reduction of radiation exposure: a case series study. Injury 39:1210–1215. https://doi.org/10.1016/j.injury.2008.04.020

    Article  PubMed  Google Scholar 

  17. Brecher ME, Monk T, Goodnough LT (1997) A standardized method for calculating blood loss. Transfusion 37:1070–1074

    Article  CAS  Google Scholar 

  18. Han B, Shi Z, Fu Y et al (2017) Comparison of free-hand fluoroscopic guidance and electromagnetic navigation in distal locking of femoral intramedullary nails. Med (Baltim). https://doi.org/10.1097/MD.0000000000007450

    Article  Google Scholar 

  19. Krettek C, Könemann B, Miclau T et al (1998) A new mechanical aiming device for the placement of distal interlocking screws in femoral nails. Arch Orthop Trauma Surg 117:147–152

    Article  CAS  Google Scholar 

  20. Veliceasa B, Bandac R, Popescu D, et al (2015) Evaluation of TRIGEN SURESHOT® distal targeting system—a new electromagnetic computer-assisted guidance system. In: 2015 E-health and bioengineering conference (EHB), pp 1–4

  21. Gausden EB, Christ AB, Zeldin R et al (2017) Tracking cumulative radiation exposure in orthopaedic surgeons and residents: what dose are we getting? J Bone Joint Surg Am 99:1324–1329. https://doi.org/10.2106/JBJS.16.01557

    Article  PubMed  Google Scholar 

  22. Shim DM, Kim YM, Oh SK et al (2014) Radiation induced hand necrosis of an orthopaedic surgeon who had treated a patient with fluoroscopy-guided spine injection. J Korean Orthop Assoc 49:250. https://doi.org/10.4055/jkoa.2014.49.3.250

    Article  Google Scholar 

  23. Anastopoulos G, Ntagiopoulos PG, Chissas D et al (2008) Distal locking of tibial nails. Clin Orthop Relat Res 466:216–220. https://doi.org/10.1007/s11999-007-0036-z

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vopat BG, Kane PM, Mansuripur PK et al (2015) The effects of distal interlocking screws on torsional stability in three-part intertrochanteric hip fractures. Springerplus. https://doi.org/10.1186/s40064-015-1196-z

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea

    Jun-Il Yoo & Sang-Youn Song

  2. Department of Radiation Oncology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea

    Hojin Jeong

  3. Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea

    Jaeboem Na

  4. Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, Korea

    Jung-Taek Kim

  5. Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea

    Yong-Han Cha

  6. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea

    Chan Ho Park

Authors
  1. Jun-Il Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hojin Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaeboem Na
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang-Youn Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung-Taek Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong-Han Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chan Ho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chan Ho Park.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The design and protocol of this study were approved by the institutional review board of Gyeongsang Medical University (GNUH-2017–06-008–003).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoo, JI., Jeong, H., Na, J. et al. Comparison of intraoperative radiation exposure with and without use of distal targeting device: a randomized control study. Arch Orthop Trauma Surg 139, 1579–1586 (2019). https://doi.org/10.1007/s00402-019-03238-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03238-z

Keywords

Search

Navigation