The utility of mini C-arm in the fixation of unstable paediatric supracondylar humeral fractures

Li, Zong Xian; Wong, Kenneth Pak Leung; Wong, Jeannie Leh Ying; Lim, Kwanghui; Mahadev, Arjandas

doi:10.1016/j.injury.2019.09.015

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…18 According to another study by Li et al which compared the conventional fluoroscopy and mini-fluoroscopy systems in patients undergoing CRPP for SHF, mini-fluoroscopy guidance employed during surgery led to prolonged operative and fluoroscopy times and an increase in the number of fluoroscopy procedures -with the added fact that Baumann's angles were similar in the two methods. 19 In the present study, both of the fluoroscopy methods led to an improvement in Baumann's angle without any significant superiority to one another, which is similar to the results provided in the literature. Evidence from prior research on SHF dictates that the removal of K wires following CRPP should be performed during the 3 rd to 4 th postoperative weeks.…”

Section: Resultssupporting

confidence: 91%

A New Fluoroscopy Technique for Supracondylar Humerus Fractures

Dağtaş

Ünal

2022

Acta ortop. bras.

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Introduction To compare two different intraoperative fluoroscopy techniques used for closed reduction and percutaneous pinning (CRPP) in pediatric patients with supracondylar humerus fractures (SHF). Materials and Methods Thirty-six patients who underwent SHF surgery from May 2011 to June 2019 were included in the study. During surgery, the classical fluoroscopy method (CFM) was used in 21 patients and the new fluoroscopy method (NFM) was used in the remaining 15 patients. Results The mean age was 5.14±1.13 years in the NFM group and 5.38±1.36 years in the CFM group. Mean operative time was 38.14±5.92 minutes in the CFM group and 21.54±3.48 minutes in the NFM group (p=0.001), while mean fluoroscopy times were 25.65±3.91 seconds and 39.84±7.50 seconds in the NFM and CFM groups, respectively (p=0.001). The NFM and CFM groups demonstrated similar functional capacity as measured by the Mayo Elbow Score (p=0.168). Direct radiographs obtained to measure Baumann’s angle also showed that the two groups had similar results (p=0.848). Conclusions The NFM is a reliable and successful technique as it leads to shorter operative and fluoroscopy times, as well as providing improvement in functional scores and radiological outcomes in short-term follow-up. Level of Evidence III, Therapeutic Studies-Investigating the Results Level of Treatment.

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Section: Resultssupporting

confidence: 91%

A New Fluoroscopy Technique for Supracondylar Humerus Fractures

Dağtaş

Ünal

2022

Acta ortop. bras.

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“…2 ) [10]. Table 3 compares the amount of radiation, during supracondylar fixation that has been measured in different studies, including our study (all units have been converted to μGy.m 2 ).…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure in The Treatment of Pediatric Supracondylar Humerus Fractures: Comparison of Two Fixation Methods

Tzatzairis¹,

Firth²,

Bijlsma³

et al. 2021

TOORTHJ

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Aim: The study aims to determine the estimated radiation exposure of two different types of fixation (crossed vs lateral-entry K-wires) for displaced supracondylar fractures at a Major Trauma Centre in London. Methods: A retrospective review was performed between 2015 and 2019 in children (<16 years old) who underwent either Closed Reduction and Percutaneous Pinning (CRPP) or open reduction and K wire fixation for a displaced supracondylar fracture (Gartland II, III and IV) of the humerus. Results: The overall mean radiation dose and duration with crossed K-wire fixation was statistically lower when compared with two lateral K-wires. The mean radiation dose increased with increasing Gartland Grade - for Gartland Grades II, III and IV respectively. Conclusion: The current study showed statistically significant decreased radiation dose in crossed K-wire fixation method, compared to lateral-entry fixation. No difference was found regarding the cosmetic/functional outcome when Flynn’s criteria were applied.

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“…Patients are exposed to short intermittent periods of radiation during surgery while surgeons and other operation theatre staff are exposed to long-term cumulative radiation which may lead to stochastic effects on various organs [5][6][7][8]. Evidence suggests that the use of mini C-arm image intensifier (MCA) has similar clinical outcomes compared to the use of conventional C-arm image intensifier (CCA), with the former giving a much lower radiation dose [9]. Despite clear evidence, it is not always possible to use MCA due to surgeon's preference and institutional availability.…”

Section: Introductionmentioning

confidence: 99%

Dose reduction for minimizing radiation in displaced paediatric supracondylar humerus fractures: single vs. automated pulse mode

Mishra¹,

Yap²,

Lee

et al. 2021

Journal of Pediatric Orthopaedics B

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Conventional C-arm image intensifiers (CCA) are an essential and indispensable aid in modern orthopaedic surgery. CCAs are defaulted to auto-pulse mode which emit multiple pulses (or bursts) of radiation to obtain optimum image quality. The number of pulses per shot can be configured manually. The purpose of this study is to investigate the efficacy of the single pulse mode of CCA in reducing and fixing paediatric supracondylar humeral fractures (SCHF). A retrospective chart review of 99 paediatric patients who underwent closed reduction and percutaneous pinning of displaced SCHF was performed. Fifty-one consecutive cases operated with auto-pulse mode (group A). Another 48 consecutive cases were operated with the singlepulse mode (group B). Baumann's angle, operative duration and average radiation dose rate were recorded for comparison between both groups. Twenty postpinning images were randomly selected (10 from each group) to study intra-and interobserver reliability. Twelve doctors were recruited and tasked to identify if each X-ray was taken with the autopulse or single-pulse mode. This was repeated after 2 weeks. The patients in the auto-pulse mode group had a significantly higher mean radiation dose of 40.4 ± 32.51 cGycm 2 /min compared to that of 14.8 ± 3.24 cGycm 2 /min for the single-pulse group (P ≤ 0.001). All patients in both groups had Baumann's angle within normal range of 64-81°. No significant difference was noted in average intraoperative timings between both groups (P = 0.869). In the majority of cases, the doctors were unable to visually differentiate between the modes of CCA used. The single-pulse mode is an excellent alternative to the auto-pulse mode in fixing SCHF. It gives significantly lower radiation without compromising the surgical outcome.

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The utility of mini C-arm in the fixation of unstable paediatric supracondylar humeral fractures

Cited by 4 publications

References 20 publications

A New Fluoroscopy Technique for Supracondylar Humerus Fractures

A New Fluoroscopy Technique for Supracondylar Humerus Fractures

Radiation Exposure in The Treatment of Pediatric Supracondylar Humerus Fractures: Comparison of Two Fixation Methods

Dose reduction for minimizing radiation in displaced paediatric supracondylar humerus fractures: single vs. automated pulse mode

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