scholarly journals Comparing Effectiveness Between a Power-Drill-Mounted Device and Conventional Free-Handed Technique for Distal Locking of Intramedullary Implants

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0022
Author(s):  
Supachoke Wattanakitkrileart ◽  
Boonsin Tangtrakulwanich ◽  
Varah Yuenyongviwat
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Operative Time ◽  
Operating Time ◽  
Surgical Team ◽  
Intramedullary Nails ◽  
Distal Locking ◽  
Orthopedic Surgeons ◽  
Power Drill ◽  
Intramedullary Implants

Objectives: The procedure for distal locking of intramedullary nails (IM nail) is one of the time-consuming procedures and also exposes the surgical team and patient to high levels of radiation. Many techniques and devices have been created to solve the problems. Nonetheless, conventional free-hand technique is still the most popular due to easy-to-use and no added device needed. This research aims to study the accuracy of a drill-mounted device with free-handed technique in the distal locking of IM nail procedure. Methods: This is an experimental study. The device was made from PVC pipes. In this study, IM-nail-inserted synthetic femoral bones (Synbone®) were set as in IM nail procedure. Four orthopedic surgeons were instructed and performed the distal locking procedure with free-handed technique and then with the device (totally 20 times for each technique). The radiation exposure time and operating time were recorded. Results: The drill-mounted device reduced the radiation exposure time statistically significant lower than the free-handed technique. However, there was no different in operative time between the two techniques. Screw misdirection occurred two times in free-handed technique but not found in our device-assisted group. Conclusion: In this experiment, the new-designed device can reduce the radiation exposure time in distal IM nail interlocking procedure. Nonetheless, further clinical study is required to confirm our results.

scholarly journals Smart glasses display device for fluoroscopically guided minimally invasive spinal instrumentation surgery: a preliminary study

2021 ◽  
Vol 34 (1) ◽  
pp. 150-154
Author(s):  
Keitaro Matsukawa ◽  
Yoshiyuki Yato
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Exposure Time ◽  
Operative Time ◽  
Spinal Instrumentation ◽  
Display Device ◽  
Intraoperative Complication ◽  
Smart Glasses ◽  
Estimated Blood Loss ◽  
Surgical Field

OBJECTIVEMost surgeons are forced to turn their heads away from the surgical field to see various intraoperative support monitors. These movements may result in inconvenience to surgeons and lead to technical difficulties and potential errors. Wearable devices that can be attached to smart glasses or any glasses are novel visualization tools providing an alternative screen in front of the user’s eyes, allowing surgeons to keep their attention focused on the operative task without taking their eyes off the surgical field. The aim of the present study was to examine the feasibility of using glasses equipped with a wearable display device that transmits display monitor data during fluoroscopically guided minimally invasive spinal instrumentation surgery.METHODSIn this pilot prospective randomized study, 20 consecutively enrolled patients who underwent single-segment posterior lumbar interbody fusion (PLIF) at L5–S1 performed using the percutaneous pedicle screw technique were randomly divided into two groups, a group for which the surgeon used a wearable display device attached to regular glasses while performing surgery (smart glasses group) and a group for which the surgeon did not use such a device (nonglasses group). Real-time intraoperative fluoroscopic images were wirelessly transmitted to the display device attached to the surgeon’s glasses. The number of head turns performed by the surgeon to view the standard fluoroscopic monitor during procedures and the operative time, estimated blood loss, radiation exposure time, screw placement accuracy, and intraoperative complication rate were evaluated for comparison between the two groups.RESULTSThe number of surgeon head turns to view the fluoroscopic monitor in the smart glasses group was 0.10 ± 0.31 times, which was significantly fewer than the head turns in the nonglasses group (82.4 ± 32.5 times; p < 0.001). The operative and radiation exposure times in the smart glasses group were shorter than those in the nonglasses group (operative time 100.2 ± 10.4 vs 105.5 ± 14.6 minutes, radiation exposure time 38.6 ± 6.6 vs 41.8 ± 16.1 seconds, respectively), although the differences were not significant. Postoperative CT showed one screw perforation in the nonglasses group, and no intraoperative complications were observed in either group.CONCLUSIONSThis is, to the authors’ knowledge, the first report on the feasibility of using this wearable display device attached to glasses for fluoroscopically guided minimally invasive spinal instrumentation surgery. Smart glasses display devices such as this one may be a valid option to facilitate better concentration on operative tasks by improving ergonomic efficiency during surgery.

scholarly journals Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures

2021 ◽  
Vol 87 (2) ◽  
pp. 305-311
Author(s):  
Karthik Vishwanathan ◽  
Keyur Akbari ◽  
Amit Patel
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Hip Fractures ◽  
Image Intensifier ◽  
University Teaching ◽  
Entire Study ◽  
Distal Locking ◽  
Femoral Nail ◽  
The Mean ◽  
Fluoroscopy Exposure

There is no study that has compared the radiation exposure during short (Short PFN) and long proximal femoral nailing (Long PFN) for 31A2 intertrochanteric hip fractures. The objective of the present study was to compare the radiation exposure time in short and long proximal femoral nail during the treatment of 31A2 intertrochanteric hip fractures. This prospective cohort study was carried out in a University teaching hospital. Sixty one consecutive patients with 31A2 intertrochanteric femur fracture treated with pro- ximal femoral nail were included in the study. The distal locking in the short PFN was performed using the locking zig and distal locking in the long PFN was performed using the free hand perfect circle technique. The same mobile image intensifier (Multimobil 5E, Siemens, Erlangen, Germany) was used in the entire study. The outcome measure was the fluoroscopy exposure time (seconds) which was measured directly from the image intensifier. Thirty patients underwent fixation with short PFN and 31 patients underwent fixation using long PFN. The mean fluoroscopy exposure time in short PFN cohort was 189.5 seconds ± 26 (range : 150-250 seconds) and the mean fluoroscopy exposure time in long PFN cohort was 283.4 seconds ± 43.8 (range : 200-400 seconds). The mean fluoroscopy exposure time was 93.9 seconds shorter in the short PFN cohort and this difference was statistically significant (p < 0.0001 ; 95% CI : 75.4 to 112.3). The radiation exposure to the operating team is significantly less during treatment with short PFN in 31A2 intertrochanteric fractures.

scholarly journals ’Endoscopy assisted distal locking of intramedullary nail’,  a new experimental technique to reduce the radiation exposure during the distal locking of the intramedullary nails.

2021 ◽  
Author(s):  
Serkan Davut ◽  
Yunus Doğramacı
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Shaft Fracture ◽  
Long Bone ◽  
Control Group ◽  
Study Group ◽  
Distal Locking ◽  
Time Period ◽  
Group 10 ◽  
Time Required

Abstract Introduction: The gold standart for treating a lower extremity long bone shaft fracture is closed reduction and internal fixation using the locking intramedullary nailing. The fracture is stable if the nail is locked distally and proximally. Usually all the aiming devices are successfull to lock the proximal but not with the distal screws. Distal locking step is the main source for radiation exposure during this type of surgery. In this study we tried to reduce the radiation exposure using an intra-nail endoscopic visualisation and illumination method for distal locking.Methods: 20 fresh bovine tibia bone were included in this study. Two groups each with 10 samples were prepared. We applied a standart nailing process in both groups, the study group (10 sample) locked by the new technic ''Intranail endoscopic illumination and visualisation locking method'' and the control group (10 sample) were locked by the free hand fluoroscopic guidance technic. We measured the surgical period time and the radiation exposure time required for distal locking procedure in both groups.Results: The radiation exposure time was statistically significantlly lower in the study group comparing to the control group. Also the time period required for distal locking in the study group were statistically significantly lower than the control group.With the use of the intranail endoscopic illumination guidance and visualisation assistance technic, the mean period time required for distal locking procedure reduced from 477,5 to 223,5 seconds (p < 0,001). The radiation exposure dramatically reduced from 13,5 to 2 seconds (p < 0,001 ). The attempt number reduced from 6,5 to 2 times (p < 0,001).Conclusions: This study showed that using a simple intranail endoscopic visualisation and illumination guidance will make the distal locking step safer by reducing the radiation exposure time and also reduce the surgical period.

scholarly journals A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze-hang Zheng ◽  
Fei Xu ◽  
Zheng-qiang Luo ◽  
Ye Ren ◽  
Tao Fu ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pelvic Fracture ◽  
Operative Time ◽  
Screw Placement ◽  
Screw Insertion ◽  
Average Operative Time ◽  
Free Hand Technique ◽  
Point To Point ◽  
Postoperative Fracture

Abstract Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS

2021 ◽  
Author(s):  
Seung Wan Hong ◽  
Tae Won Kim ◽  
Jae Hun Kim
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Exposure Time ◽  
The Other ◽  
Lead Apron ◽  
Type Group ◽  
Air Kerma ◽  
Different Types ◽  
The Relationship

Abstract Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p &lt; 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.

Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants

Injury ◽  
2004 ◽  
Vol 35 (6) ◽  
pp. 567-574 ◽  
Author(s):  
Norbert Suhm ◽  
Peter Messmer ◽  
Ivan Zuna ◽  
Ludwig A Jacob ◽  
Pietro Regazzoni
Keyword(s):  
Surgical Navigation ◽  
Fluoroscopic Guidance ◽  
Distal Locking ◽  
Intramedullary Implants
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