Review of the Clinical Use of Fluoroscopy in Hand Surgery

Gieroba, Tom J.; Bain, Gregory I.; Cundy, Peter

doi:10.1142/s021881041530003x

Cited by 14 publications

(14 citation statements)

References 35 publications

(29 reference statements)

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“…2,3 The previous methods of assessing dynamic disorders of the wrist have included plain radiographs and fluoroscopy. 4,5 Examples of radiographs include those in radial and ulnar deviation, and clenched fist views. 6 Fluoroscopy can be used to assess carpal motion and instability, 6 aid in intra-articular injections, 7 and be of value in the operating theater.…”

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confidence: 99%

Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility

et al. 2018

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Background Four-dimensional computed tomography (4D CT) is a rapidly developing diagnostic tool in the assessment of dynamic upper limb disorders. Functional wrist anatomy is incompletely understood, and traditional imaging methods are often insufficient in the diagnosis of dynamic disorders. Technique This study has developed a protocol for 4D CT of the wrist, with the aim of reviewing the clinical utility of this technology in surgical assessment. A Toshiba Aquilion One Vision scanner was used in the protocol, in which two- and three-dimensional “static” images, as well as 4D “dynamic” images were produced and assessed in the clinical context of each patient. These consisted of a series of multiple 7-second movement clips exploring the nature and range of joint motion. Patients and Methods Nineteen patients with symptoms of dynamic instability were included in the study. Patients were assessed clinically by two orthopaedic surgeons, and qualitative data were obtained from radiological interpretation. Results The study demonstrated varied abnormalities of joint movement attributed to a range of wrist pathology, including degenerative arthritis, ligamentous injuries, Kienbock's disease, and pain following previous surgical reconstructive procedures. Interpretation of the 4D CT scan changed the clinical diagnosis in 13 cases (68.4%), including the primary (15.8%) or secondary diagnosis (52.6%). In all cases, the assessment of the dynamic wrist motion assisted in understanding the clinical problem and led to a change in management in 11 cases (57.9%). The mean effective radiation dose for the scan was calculated at 0.26 mSv. Conclusion We have found that the clinical utility of 4D CT lies in its ability to provide detailed information about dynamic joint pathology not seen in traditional imaging, targeting surgical treatment. Limitations to the use of 4D CT scan include lack of availability of the technology, potential radiation dose, and radiographer training requirements, as well as limited understanding of the nature of normal motion.

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confidence: 99%

Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility

et al. 2018

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“…2a and 2b). Many studies have emphasized the need to educate and protect everyone in the room during uoroscopy [24,25] . The mean duration of radiation exposure was 2.87 ± 1.19 min in our PELD group.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Paraspinal Muscle-Splitting Microscopic-Assisted Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy on Patients in the Treatment of Far-Lateral Lumbar Disc Herniation

Kong

Zhang

2020

Preprint

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Background: Minimally invasive surgery includes percutaneous endoscopic lumbar discectomy and the microscopic tubular technique. This study aimed to compare the two techniques and evaluate the outcomes of the procedures.Methods: We retrospectively analyzed patients with far-lateral lumbar disc herniation (FLLDH) from June 2015 to October 2018. Twenty-six patients underwent paraspinal muscle-splitting microscopic-assisted discectomy (MD) and 30 patients underwent percutaneous endoscopic lumbar discectomy (PELD) surgery by the same surgical team. Data included the duration of the operation, duration of intraoperative radiation exposure, and average duration of hospitalization. Pre- and postoperative pain scores and neurological functions were recorded using a visual analog scale (VAS) score and Oswestry disability index (ODI).Results: 56 patients remained in the study over the 12–24 months period. The mean operating time was 65.83 ± 16.64 min in the PELD group, mean duration of radiation exposure was 2.87 ± 1.19 min, and average of hospitalization was 3.43 days. The mean operating time was 44.96 ± 16.87 min in the MD group, duration of radiation exposure was 0.78 ± 0.32 min, and duration of hospitalization was 4.12 days. There were two patients with postoperative transient dysesthesia and one underwent reoperation 7 months after surgery in the PELD group. One patient had postoperative transient dysesthesia in the MD group. Except low back pain at 3 months (p >0.05), all patients in both groups showed significant improvement in VAS and ODI scores compared with pre-operation and until final follow-up (p<0.05). Although the learning curve of MD is shorter compared with the PELD, beginners should practice on cadavers and receive teaching demonstrations from senior surgeons.Conclusion: Both techniques are minimally invasive, effective, and safe for treating far-lateral lumbar disc herniation in selected patients. Compared with the PELD technique, the MD procedure offers a wider field of vision during operation, shorter operation time, fewer postoperative complications, and shorter learning curve.

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“…Mini C-arm image intensifiers (IIs) have been reported to have lower radiation doses to patients 4 and operating personnel. [5][6][7][8] Scatter is one or two orders of magnitude lower. 4 The smaller radius of the mini C-arm allows lower beam power and greater collimation.…”

Section: Introductionmentioning

confidence: 99%

“…Local legislation varies in Australia and New Zealand; generally consultant surgeons can be licenced and in some states trainees also. 8 Other centres have reported a 15% decrease in radiographer workload and reduced delays following introduction of a mini Carm II. 11 A Canadian study of metacarpal fracture fixation noted that introduction of a mini C-arm allowed 19 min shorter procedure time and 24 min shorter in-theatre time.…”

Section: Introductionmentioning

confidence: 99%

“…In South Australia, orthopaedic consultants and registrars who are trained and licenced by the Environmental Protection Authority may operate the machine for imaging limbs, distal to and including the knee and shoulder. Local legislation varies in Australia and New Zealand; generally consultant surgeons can be licenced and in some states trainees also …”

Section: Introductionmentioning

confidence: 99%

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