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Intraoperative Fluoroscopy in Distal Radius Fracture Fixation: Does C-Arm Size Matter?
Camren S Toole, BS, Lauren Lautenslager, MD, Christopher Ingersol, MD; Anthony J Archual, MD
Indiana University, Indianapolis, IN
Introduction:
Distal radius fractures are among the most common upper extremity injuries, with over 20% managed surgically in the United States (1,2). Intraoperative fluoroscopy is essential to ensure proper alignment and fixation application (3), yet no prior studies have directly compared the use of mini versus full C-arm fluoroscopy in this setting. This study aims to evaluate whether one imaging modality provides superior clinical or operative outcomes.
Methods:
A retrospective review was conducted of all surgically managed, isolated distal radius fractures performed by five fellowship-trained hand surgeons at a Level I trauma center and affiliated locations between September 2020 and March 2024. Data collected included patient demographics, fluoroscopy modality, radiation dose, fluoroscopy time, number of images captured, tourniquet time, operative time, and reoperation rate. Categorical variables were compared using Chi-square testing, and continuous variables were analyzed with Welch's t-tests using GraphPad Prism v10.5.0.
Results:
A total of 468 procedures in 452 patients met inclusion criteria. The mean patient age was 51 years, and 64.7% were female. After excluding planned hardware removal procedures, reoperation rates were identical between groups (4.02%; p = 0.9989). Compared to the full C-arm, the mini C-arm group had significantly more images captured (83.61 vs 56.28; p = 0.0002), longer fluoroscopy time (186.9 vs 45.97 seconds; p < 0.0001), and higher radiation exposure (21.92 vs 1.278 mGy; p < 0.0001). Additionally, tourniquet time and operative duration were significantly longer in the mini C-arm group by 25.2 minutes (91.78 vs 66.58) and 33.13 minutes (117.7 vs 84.57), respectively (both p < 0.0001).
Conclusions:
Use of the full C-arm in distal radius fracture fixation is associated with shorter operative and tourniquet times, and significantly lower radiation exposure for both patient and surgeon compared to the mini C-arm, without increasing reoperation risk. Full C-arm fluoroscopy may offer a safer and more efficient intraoperative imaging strategy in the management of distal radius fractures.
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