Tibia
‘Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures: introduction of the ‘C-Arm Rotational View (CARV)’
Nils Jan Bleeker , Job N. Doornberg, Kaj ten Duis, Mostafa El Moumni1, Inge H. F. Reininga, Ruurd L. Jaarsma, Frank F. A. IJpma. On behalf of the Traumaplatform 3D Consortium
Rotational malalignment (≥10°) is a frequent pitfall of intramedullary-nailing of tibial shaft fractures. This study aimed to develop an intraoperative fuoroscopy protocol, coined ‘C-Arm Rotational View (CARV)’, to signifcantly reduce the risk for rotational malalignment and to test its clinical feasibility
Results: In total, 180 rotational corrections were performed by 10 surgeons. Correction according to clinical practice using single-leg and dual-leg draping resulted in a median diference of, respectively, 10.0° (IQR 5.0°) and 10.0° (IQR 5.0°) relative to neutral alignment. Single-leg and dual-leg draping resulted in malalignment (≥10°) in, respectively, 67% and 58% of the corrections. Standardized correction using the CARV resulted in a median diference of 5.0° (IQR 5.0°) relative to neutral alignment, with only 12% categorized as malalignment (≥10°). The incidence of rotational malalignment after application of the CARV decreased from 67% and 58% to 12% (p= <0.001). Both consultants and residents successfully applied the CARV-protocol. Finally, three clinical patients with a tibial shaft fracture were treated according to the CARV-protocol, resulting all in acceptable alignment (<10°) based on postoperative CT-measurements.
Conclusion: This study introduces an easy-to-use and clinically feasible standardized intraoperative fuoroscopy protocol coined ‘C-arm rotational view (CARV)’ to minimize the risk for rotational malalignment following intramedullary-nailing of tibial shaft fractures.