The Effect of C-Arm Mobility and Field of Vision on Radiation Exposure in the Treatment of Proximal Femoral Fractures: A Randomized Clinical Trial

الملخص EN

Objectives.

To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures.

Design.

Single-center, randomized, prospective study.

Setting.

Academic Level I trauma hospital.

Patients and Intervention.

34 patients treated with cephalomedullary nailing for a stable, intertrochanteric proximal femur fracture (OTA A1).

Main Outcome Measurement.

The total working time of the fluoroscopy device, the dose-area product (DAP), operating time, reduction quality (cortical continuity, symmetrical collodiaphyseal angle, and shortness), and fixation quality (Bosworth quadrants, the tip-apex distance, TAD).

Results.

There were no cases of poor reduction; also the placement of the blade was optimal for 14 patients and suboptimal in 3 patients in each group.

Superior-posterior placement of the blade or TAD > 25 mm was not seen in any patient.

Total operating time was significantly shorter when using device A compared to the use of device B (20.1±3.4 mins versus 25.3±5.4 mins, p<0.001).

Total radiation time was significantly shorter with device A compared to the use of device B (58.1±19.4 secs versus 98.9 ± 55.4 secs, p=0.008).

The measured radiation dose was lower with the use of device A compared to device B (3.5 ± 1.2 Gy·cm2 versus 7.3 ± 4.5 Gy·cm2, p=0.002).

Conclusion.

Physical properties of fluoroscopy devices used during the fixation of intertrochanteric fractures could yield significant differences in operating times and the radiation dose while having comparable clinical results.