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Fluoroscopic Marker-Based Guidance System Improves Gamma Lag Screw Placement During Nailing of Intertrochanteric
Simon Weidert1, Fabian Sommer1, Eduardo M Suero1
1Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
Objectives:
To determine whether a fluoroscopy-based navigation system would improve tip-apex distance (TAD) compared with the conventional technique.
Design:
Randomized controlled trial.
Setting:
Level 1 trauma center.
Patients:
A total of 161 patients were screened for inclusion in the study. After meeting inclusion and exclusion criteria, 31 patients were randomized (n = 18 navigated vs. n = 13 control group), with the patient blinded to the result.
Intervention:
Fluoroscopy-based navigated guidance of lag screw length and position.
Main Outcome Measures:
Average TAD and the proportion of TAD over 25 mm.
Results:
TAD was lower in the navigated group compared with the control group (mean = 17.5 vs. 24.2 mm; P = 0.0018). No navigated cases exceeded the 25 mm TAD threshold, compared with 39% of conventional cases (P = 0.0076). Navigation resulted in fewer drilling attempts compared with the conventional technique (median = 1 vs. 4 attempts; P < 0.0001). We detected no significant differences in operation time or total number of fluoroscopic images (P > 0.05).
Conclusions:
Fluoroscopy-based computer navigated Gamma nailing for intertrochanteric fractures improved TAD and reduced the number of drilling attempts without increasing operation time compared with the conventional fluoroscopy-guided technique in a teaching hospital setting.
Level Of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
