Abstract
Objectives
Intramedullary (IM) nailing is the preferred method for treatment of femoral shaft fractures. However, for the surgical staff and the patients, exposure to large dose of X-rays is inevitable during the procedure. In this paper, a new technique based on ultrasound is proposed to guide the reduction of femoral fractures, reducing radiation exposure.
Methods and results
By means of particular continuous transverse and multiplanar longitudinal scanning, the deformity pattern information of the fracture could be efficiently acquired. Adequate reduction could be achieved under the real-time guidance of intraoperative ultrasound.
Conclusions
Intraoperative ultrasound can guide the reduction of femoral shaft fracture using IM nailing, and reduce the radiation exposure of medical staff and patients.
References
Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17(5):296–305
Rhorer AS (2009) Percutaneous/minimally invasive techniques in treatment of femoral shaft fractures with an intramedullary nail. J Orthop Trauma 23(5 Suppl):S2–S5. https://doi.org/10.1097/BOT.0b013e31819f2569
Matityahu A, Duffy RK, Goldhahn S, Joeris A, Richter PH, Gebhard F (2017) The Great Unknown—a systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries. Injury 48(8):1727–1734. https://doi.org/10.1016/j.injury.2017.04.041
Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B (2005) Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond) 55(6):498–500. https://doi.org/10.1093/occmed/kqi048
Iagnocco A, Naredo E, Bijlsma JW (2013) Becoming a musculoskeletal ultrasonographer. Best Pract Res Clin Rheumatol 27(2):271–281. https://doi.org/10.1016/j.berh.2013.02.004
Grechenig W, Clement HG, Fellinger M, Seggl W (1998) Scope and limitations of ultrasonography in the documentation of fractures—an experimental study. Arch Orthop Trauma Surg 117(6–7):368–371
Chen L, Kim Y, Moore CL (2007) Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care 23(8):528–531. https://doi.org/10.1097/PEC.0b013e318128f85d
Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI (2010) Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med 17(7):687–693. https://doi.org/10.1111/j.1553-2712.2010.00788.x
Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B (2016) Ultrasound in the diagnostics of metaphyseal forearm fractures in children: a systematic review and cost calculation. Pediatr Emerg Care 32(6):401–407. https://doi.org/10.1097/PEC.0000000000000446
Durston W, Swartzentruber R (2000) Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med 18(1):72–77
Degreif J, Wenda K (1998) Ultrasound-guided spinal fracture repositioning. Surg Endosc 12(2):164–169
Mueller LA, Degreif J, Schmidt R, Pfander D, Forst R, Rommens PM, Mueller LP, Rudig L (2006) Ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. Spine 31(20):E739–E746. https://doi.org/10.1097/01.brs.0000237012.83128.80 (discussion E747)
Gulicher D, Krimmel M, Reinert S (2006) The role of intraoperative ultrasonography in zygomatic complex fracture repair. Int J Oral Maxillofac Surg 35(3):224–230. https://doi.org/10.1016/j.ijom.2005.10.005
Soejima K, Sakurai H, Nozaki M, Kitazawa Y, Takeuchi M, Yamaki T, Kono T (2009) Semi-closed reduction of tripod fractures of zygoma under intraoperative assessment using ultrasonography. J Plast Reconstr Aesthet Surg 62(4):499–505. https://doi.org/10.1016/j.bjps.2007.11.007
Pape HC, Tarkin IS (2009) Intraoperative reduction techniques for difficult femoral fractures. J Orthop Trauma 23(5 Suppl):S6–S11. https://doi.org/10.1097/BOT.0b013e31819f2754
Tornetta P III, Ritz G, Kantor A (1995) Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma 38(2):213–219
Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, Sanders R (2001) Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 15(2):90–95
Rüedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management, 2nd edn. Thieme, Stuttgart
Karaman O, Ayhan E, Kesmezacar H, Seker A, Unlu MC, Aydingoz O (2014) Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life. Eur J Orthop Surg Traumatol 24(7):1243–1247. https://doi.org/10.1007/s00590-013-1289-8
Ehrenstein T, Rikli DA, Peine R, Gutberlet M, Mittlmeier T, Banzer D, Maurer J, Felix R (1999) A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures. Skeletal Radiol 28(6):336–341. https://doi.org/10.1007/s002560050527
Rowlands R, Rippey J, Tie S, Flynn J (2017) Bedside ultrasound vs X-ray for the diagnosis of forearm fractures in children. J Emerg Med 52(2):208–215. https://doi.org/10.1016/j.jemermed.2016.10.013
Somerson JS, Rowley D, Kennedy C, Buttacavoli F, Agarwal A (2014) Electromagnetic navigation reduces surgical time and radiation exposure for proximal interlocking in retrograde femoral nailing. J Orthop Trauma 28(7):417–421. https://doi.org/10.1097/BOT.0000000000000029
Langfitt MK, Halvorson JJ, Scott AT, Smith BP, Russell GB, Jinnah RH, Miller AN, Carroll EA (2013) Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients. J Orthop Trauma 27(7):367–372. https://doi.org/10.1097/BOT.0b013e31828c2ad1
Kesavachandran CN, Haamann F, Nienhaus A (2012) Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review. Eur J Med Res 17:28. https://doi.org/10.1186/2047-783x-17-28
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Zhe, Z., Jianjin, Z., Fei, S. et al. Intraoperative ultrasound-guided reduction of femoral shaft fractures using intramedullary nailing: a technical note. Arch Orthop Trauma Surg 139, 589–596 (2019). https://doi.org/10.1007/s00402-018-3085-8
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DOI: https://doi.org/10.1007/s00402-018-3085-8