Key result
The intraoperative 150° tangential fluoroscopic view successfully identified posterosuperior screw in-out-in placement in 8 of 33 patients that were completely missed by standard anteroposterior and lateral views.
Why the study?
The study investigated the application of a 150° tangential fluoroscopic projection as a novel view to detect posterosuperior screw in-out-in during inverted triangle cannulated screw fixation of femoral neck fractures.
Does the intra-operative 150° tangential fluoroscopic view improve the detection of posterosuperior screw in-out-in position compared to standard AP and lateral views in patients with femoral neck fractures?
Cohort (n=33)
No
Does the intra-operative 150° tangential fluoroscopic view improve the detection of posterosuperior screw in-out-in position compared to standard AP and lateral views in patients with femoral neck fractures?
The intra-operative 150° tangential fluoroscopic view effectively identifies posterosuperior screw in-out-in placement during femoral neck fracture fixation, overcoming the limitations of standard AP and lateral views.
150° tangential view may aid IOI screw detection in femoral neck fixation; hypothesis-generating before routine adoption.
Objective: This study investigates the application of the 150° tangential fluoroscopic projection as a novel fluoroscopic view to detect the posterosuperior screw in-out-in (IOI) in the inverted triangle cannulated screws fixation of femoral neck fractures.Methods: A retrospective analysis was conducted including 33 patients with femoral neck fractures enrolled from April to November 2021. All patients underwent closed reduction and internal fixation with inverted triangular cannulated screws under intra-operative C-arm fluoroscopy. The posterosuperior femoral neck screw position (whether in-out-in and the distance to the femoral neck cortex) was evaluated from the standard anteroposterior (AP), lateral view, and tangential view images. Postoperative computed tomography (CT) scan results are considered the gold standard for detecting the femoral neck screw locations.Results: Of 33 patients, no femoral neck screws were found to be placed IOI under the standard AP and lateral views. The tangential view revealed the posterosuperior screw was IOI in 8 patients, whereas the average distance between the posterosuperior screw and the posterior femoral neck cortex was 2.73±1.06 mm under the standard lateral view. Postoperative CT verified that posterosuperior screw was placed IOI in these 8 patients. In the other 25 patients, the average distance between the posterosuperior screw and the posterior femoral neck cortex was 5.48±1.26 mm under the standard lateral view and 2.76±1.08 mm under the tangential view, with a statistically significant difference between the two groups (p<0.05). Post-operative CT demonstrated that the femoral neck screws were completely contained in the femoral neck in these 25 patients.Conclusions: Intra-operative tangential view of 150° can effectively identify the posterosuperior screw IOI in the inverted triangle cannulated screws fixation of femoral neck fractures. Based on our study, we highly recommend the tangential view as a routine intraoperative fluoroscopic angle to avoid the posterosuperior screw IOI.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2022) conducted a cohort in Femoral neck fractures (n=33). 150° tangential fluoroscopic view vs. Standard anteroposterior and lateral views was evaluated on Detection of posterosuperior screw in-out-in (IOI). The intraoperative 150° tangential fluoroscopic view successfully identified posterosuperior screw in-out-in placement in 8 of 33 patients that were completely missed by standard anteroposterior and lateral views.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: