• Arch Orthop Trauma Surg · Nov 2019

    Randomized Controlled Trial Comparative Study

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

    • Jun-Il Yoo, Hojin Jeong, Jaeboem Na, Sang-Youn Song, Jung-Taek Kim, Yong-Han Cha, and Chan Ho Park.
    • Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea.
    • Arch Orthop Trauma Surg. 2019 Nov 1; 139 (11): 1579-1586.

    IntroductionWhen 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 MethodsInclusion 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.ResultsA 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.ConclusionThe 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.

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