Fluoroscopy and Radiographs for Detecting Retained Surgical Needles in the Hand

When a surgical needle is lost, the protocol is to explore the surgical field and to obtain a plain radiograph if the needle cannot be located. The size of the needle that can be detected with imaging is debated. Plain-film radiographs, C-arm, and mini C-arm fluoroscopy imaging was obtained of a cadaveric hand with retained needle of varying lengths (suture sizes 4-0 - 10-0). The authors performed analyses to determine the sensitivity and specificity of the imaging modalities. There were no differences in diagnostic area under the receiver operating characteristic curve between the three modalities. For plain film, optimal cutoff for needle size was 5.2 mm (sensitivity 0.87, specificity 0.75), for C-arm 6.8 mm (sensitivity 0.84, specificity 0.87), and for mini C-arm 5.9 mm (sensitivity 0.82, specificity 0.86). In the hand, the use of C-arm fluoroscopy is as sensitive as plain-film radiography at detecting retained needles greater than 5.9 mm. (Journal of Surgical Orthopaedic Advances 33(1):026-028, 2024).