Weidert, Simon;
Sommer, Fabian;
Suero, Eduardo M.;
Becker, Christopher A.;
Pieske, Oliver;
Greiner, Axel;
Kammerlander, Christian;
Böcker, Wolfgang;
Grote, Stefan
Fluoroscopic Marker–Based Guidance System Improves Gamma Lag Screw Placement During Nailing of Intertrochanteric Fractures: A Randomized Controlled Trial
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Media type:
E-Article
Title:
Fluoroscopic Marker–Based Guidance System Improves Gamma Lag Screw Placement During Nailing of Intertrochanteric Fractures: A Randomized Controlled Trial
Contributor:
Weidert, Simon;
Sommer, Fabian;
Suero, Eduardo M.;
Becker, Christopher A.;
Pieske, Oliver;
Greiner, Axel;
Kammerlander, Christian;
Böcker, Wolfgang;
Grote, Stefan
Description:
<jats:sec>
<jats:title>Objectives:</jats:title>
<jats:p>To determine whether a fluoroscopy-based navigation system would improve tip-apex distance (TAD) compared with the conventional technique.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design:</jats:title>
<jats:p>Randomized controlled trial.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Setting:</jats:title>
<jats:p>Level 1 trauma center.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Patients:</jats:title>
<jats:p>A total of 161 patients were screened for inclusion in the study. After meeting inclusion and exclusion criteria, 31 patients were randomized (n = 18 navigated vs. n = 13 control group), with the patient blinded to the result.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Intervention:</jats:title>
<jats:p>Fluoroscopy-based navigated guidance of lag screw length and position.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Main Outcome Measures:</jats:title>
<jats:p>Average TAD and the proportion of TAD over 25 mm.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>TAD was lower in the navigated group compared with the control group (mean = 17.5 vs. 24.2 mm; <jats:italic toggle="yes">P</jats:italic> = 0.0018). No navigated cases exceeded the 25 mm TAD threshold, compared with 39% of conventional cases (<jats:italic toggle="yes">P</jats:italic> = 0.0076). Navigation resulted in fewer drilling attempts compared with the conventional technique (median = 1 vs. 4 attempts; <jats:italic toggle="yes">P</jats:italic> < 0.0001). We detected no significant differences in operation time or total number of fluoroscopic images (<jats:italic toggle="yes">P</jats:italic> > 0.05).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>Fluoroscopy-based computer navigated Gamma nailing for intertrochanteric fractures improved TAD and reduced the number of drilling attempts without increasing operation time compared with the conventional fluoroscopy-guided technique in a teaching hospital setting.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Level of Evidence:</jats:title>
<jats:p>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</jats:p>
</jats:sec>