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Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing |
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| Institution: | 1. Trauma & Orthopaedics, St George’s University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom;2. Department of Radiology, St George’s University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom;1. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany;2. Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany;3. Center for Trauma Surgery, Orthopedics and Sports Medicine, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany;1. AUVA-Trauma Hospital Graz, Graz, Austria;2. Department of Orthopaedics and Trauma Surgery, Medical University of Graz, Graz, Austria;3. Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria;4. Institute of Clinical Gross Anatomy, Medical University of Graz, Graz, Austria;5. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria;6. Department of Trauma Surgery, State Hospital Wolfsberg, Wolfsberg, Austria;1. MB BCh BAO MCh Connolly Hospital, Blanchardstown, Dublin, Ireland;2. FRCSI Connolly Hospital, Blanchardstown, Dublin, Ireland;1. Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany;2. Institute for Cardiovascular Physiology, Goethe-University, Germany;1. Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran;2. Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran;3. Department of Oral and Maxillofacial Radiology, Hamadan University of Medical Sciences, Hamadan, Iran;4. Faculty of Dentistry, Hamadan University of Medical sciences, Hamadan, Iran;5. Department of Biostatistics and Epidemiology, Hamadan University of medical sciences, Hamadan, Iran |
| Abstract: | BackgroundFractures of the tibial shaft are routinely managed with intramedullary nailing. An increasingly accepted technique is the suprapatellar extended leg method. The aim of this study was to investigate whether the suprapatellar tibial nailing technique offers shorter intraoperative fluoroscopy times and lower radiation doses when compared to the traditional infrapatellar technique.Study design and methodsData from 200 consecutive intramedullary tibial nailing operations in our level 1 Major Trauma Centre were retrospectively collected from a prospective database (January 2014–December 2017). Only acute diaphyseal nailing procedures were included. The operations were performed by seven senior trauma consultants experienced in both suprapatellar and infrapatellar tibial nailing. The operations were divided into two groups: infrapatellar and suprapatellar. Intraoperative radiation time and dose data were collected.ResultsA total of 90 cases were included and analysed. The majority of the patients were male (82%). 37 operations were infrapatellar and 53 were suprapatellar. Independent samples t-test revealed lower radiation time and dose for the suprapatellar group. The infrapatellar group had a mean radiation time of 129.7 ± 56.6 s versus 94.4 ± 47.9 s for the suprapatellar group. The infrapatellar group had a mean radiation dose (Dose Area Product) 53.6 ± 34.2 cGY cm2 versus 38.2 ± 26.7 cGY cm2 for the suprapatellar group. The difference in mean radiation time and mean radiation dose were both significant (p = 0.002 and p = 0.02 respectively).ConclusionsSuprapatellar tibial nailing is an increasingly accepted technique in the management of tibial fractures. It is shown here that amongst surgeons experienced in both suprapatellar and infrapatellar nailing techniques, the suprapatellar approach trends towards lower use of intra-operative fluoroscopy as measured by time and dose and thus potentially lower radiation exposure to the operating surgeon, assistants and patient. |
| Keywords: | Tibial nail Tibia fracture Proximal tibial fractures Suprapatellar tibial nail Fluoroscopy Radiation exposure Surgical technique |
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