Fluoroscopy and Radiographs for Detecting Retained Surgical Needles in the Hand.

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Lost surgical needles pose a risk in surgical procedures.
• Standard protocol involves exploration and radiography for localization.
• The minimum detectable needle size across imaging modalities is debated.

Purpose of the Study:

• To compare the sensitivity and specificity of plain-film radiography, C-arm fluoroscopy, and mini C-arm fluoroscopy in detecting retained surgical needles in a cadaveric hand model.
• To determine optimal size cutoffs for needle detection with each imaging modality.

Main Methods:

• A cadaveric hand model was used with retained needles of varying sizes (suture sizes 4-0 to 10-0).
• Plain-film radiographs, C-arm fluoroscopy, and mini C-arm fluoroscopy images were acquired.
• Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic performance.

Main Results:

• No significant differences in the area under the ROC curve were found between the three imaging modalities.
• Optimal needle size cutoffs for detection were identified: 5.2 mm for plain film, 6.8 mm for C-arm, and 5.9 mm for mini C-arm.
• C-arm fluoroscopy demonstrated comparable sensitivity to plain-film radiography for detecting needles larger than 5.9 mm.

Conclusions:

• C-arm fluoroscopy is a viable and sensitive alternative to plain-film radiography for detecting retained surgical needles in the hand.
• The study provides evidence supporting the use of fluoroscopic imaging for lost needle localization in orthopedic surgery.
• Specific size thresholds for detection vary slightly by modality, but overlap exists for clinically relevant needle sizes.