A Targeting Arm for Interlocking Screws Reduces Radiation Exposure: Results of a Prospective Randomized Controlled...

Area of Science:

• Orthopedic surgery
• Surgical techniques
• Trauma care

Background:

• Interlocking screws are crucial for stabilizing tibial and femoral fractures treated with intramedullary nails.
• Accurate screw placement minimizes complications and ensures optimal fracture healing.
• Fluoroscopic imaging is essential but contributes to radiation exposure for patients and staff.

Purpose of the Study:

• To compare the efficacy of a targeting arm versus the perfect circle technique for placing far interlocking screws in tibial and femoral nails.
• To evaluate differences in fluoroscopic utilization, operative time, and screw placement accuracy.

Main Methods:

• Prospective randomized controlled trial conducted at a level 1 trauma center.
• Included patients aged 18+ with tibia or femur fractures (AO/OTA 31A, 32, or 42) undergoing intramedullary nailing.
• Compared outcomes between a targeting arm (Targeter) group and a perfect circle technique (Control) group.

Main Results:

• The Targeter group used significantly fewer fluoroscopic images for screw placement compared to the Control group (p < 0.002).
• No significant difference in operative time was observed between the Targeter and Control groups (p > 0.31).
• A trend towards an increased number of missed screws was noted in the Targeter group (5.4% vs 1.4%, p=0.31).

Conclusions:

• A targeting arm effectively reduces fluoroscopic image use during interlocking screw placement for tibial and femoral fractures.
• The use of a targeting arm did not reduce operative time and showed a trend toward increased screw misplacement.
• Surgeons should weigh the benefits of reduced radiation exposure against the potential for increased screw misses when using a targeting arm.