title: 2D-fluoroscopic based navigation for Gamma 3 nail insertion versus conventional procedure- a feasibility study.
abstract: BACKGROUND
  Intramedullary nailing is a standard surgical procedure for fixation of proximal femoral fractures, but is associated with considerable radiation exposure for controlling the implant placement, due to the percutaneous insertion technique.The aim of this study was the evaluation of potential benefits of 2D-fluoroscopic based navigation focused on the reduction of radiation exposure, a decrease of procedure time, as well as an increase of accuracy for Gamma3 nail insertions.
  
  
  METHODS
  Twenty randomized Gamma3 nail insertions were performed in non-fractured synthetic femora according to the manufactures operation guidelines (group I) or with use of a 2D-fluoroscopic based navigation system (group II). Time of different steps of the procedure and the radiation exposure were measured, as well as the accuracy evaluated in postoperative CT scans.
  
  
  CONCLUSIONS
  All Gamma3 nails were placed without any technical problems. Independent of the used procedure, the overall operating time (group I: 584 ± 99.2 sec; group II: 662 ± 64.9 sec; p=0.06) and accuracy of the final nail-positions were equivalent, but the radiation exposure was significantly reduced (92% reduction in fluoroscopic images and 91% reduction in fluoroscopic time, p< 0.01), using the 2D fluoroscopic based navigation procedure.
  
  
  CONCLUSIONS
  2D-fluoroscopic based navigation for Gamma3 nail insertion facilitates a relevant reduction of radiation exposure with equivalent accuracy of the final implant position and no prolonged operating time. This promising procedure modification is independent of different cephalomedullary implant manufacturers and specific implant designs, but needs to be evaluated in further clinical settings.
authors: Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena 07747, Germany. Arne.Wilharm@med.uni-jena.de
authors: A
authors: A
authors: Wilharm
authors: I
authors: I
authors: Marintschev
authors: G O
authors: GO
authors: Hofmann
authors: F
authors: F
authors: Gras
mesh_terms: D001858:Bone Nails; D005240:Feasibility Studies; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005471:Fluoroscopy; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D011829:Radiation Dosage; D015641:Radiography, Interventional; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013997:Time Factors