Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study

KONYA, Mehmet Nuri; Aslan, Ahmet; Gülcü, Anıl; SARGIN, Assoc.Prof. Serdar

doi:10.14744/tjtes.2020.94490

Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study

Ahmet ASLAN, (Alanya Alaaddin Keykubat Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Antalya, Türkiye)

Mehmet Nuri KONYA, (Afyon Sağlık Bilimleri Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Afyonkarahisar, Türkiye)

Anıl GÜLCÜ, (Alanya Alaaddin Keykubat Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Antalya,Türkiye)

Serdar SARGIN (Balıkesir Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Balıkesir, Türkiye)

Ulusal Travma ve Acil Cerrahi Dergisi

2 0

Yıl: 2020 Cilt: 26 Sayı: 2 Sayfa Aralığı: 280 - 286 Metin Dili: İngilizce DOI: 10.14744/tjtes.2020.94490 İndeks Tarihi: 05-10-2020

Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study

Öz:

ABSTRACTBACKGROUND: Intramedullary nailing (IMN) technique is the gold standard for the treatment of closed fractures of the lower extremity long bones. For orthopedic surgeons, one of the most important problems in IMN procedures is the fixation of distal locking screws (DLS). Accurate and rapid placement of DLSs with minimal radiation exposure is crucial. In this study, we aimed to compare the results of two different distal locking methods concerning surgery duration and radiation exposure in patients who underwent osteosynthesis of tibia fractures with IMN.METHODS: In this prospective study, the results of 56 patients who met the inclusion and exclusion criteria from 72 patients were evaluated. Patients were divided into two groups according to the distal screwing method. Group 1 (n=29) comprised patients who used free-hand technique (FHT) for distal locking, while Group 2 (n=27) consisted of patients who used electromagnetic guidancesystem (EMGS) for distal locking. Demographic and medical data of the patients, duration of surgery time, amount of bleeding, total fluoroscopy counts, the time elapsed for distal locking, the measure of radiation exposure, number of attempts for distal screw locking, incorrect screw placements, complications and follow-up time were recorded. The groups were compared concerning demographicdata and clinical results.RESULTS: There was no statistically significant difference between the groups about gender and side (p=0.928 and p=0.432, respectively). The mean age in Group-1 was higher than that of Group-2, and the difference was statistically significant (p=0.012). However, there was no statistically significant difference in length of hospital stay in Group-1 (p=0.140). On the other hand, in Group-2, thenumber of distal shots, fluoroscopy duration, effective radiation dose and operation duration were lower compared to Group-1, although this difference was not statistically significant (p=0.057, 0.073, 0.058 and 0.056, respectively). Failure was encountered in distal locking during the first attempt in three cases in Group-1 and in two cases in Group-2. Aseptic nonunion was observed in one patientin both groups.CONCLUSION: Both the FHT distal screwing technique and the EMGS distal screwing technique are highly effective methods for distal locking. The duration of operation, the duration of the fluoroscopy and radiation exposure were similar. FHT can be preferred for distal locking in conventional intramedullary nail applications, as it is effective, easy and inexpensive.

Anahtar Kelime:

Tibia kırıklarının intramedüller çivilemesinde, distal kilitleme için elektromanyetik yönlendirme sistemi, serbest el tekniğinden üstün müdür? İleriye yönelik karşılaştırmalı bir çalışma

Öz:

AMAÇ: İntramedüller çivileme (İMÇ) tekniği, alt ekstremite uzun kemiklerinin kapalı kırıklarının tedavisinde altın standarttır. Ortopedik cerrahlar için İMÇ prosedürlerindeki en önemli sorunlardan biri distal kilitleme vidalarının (DKV) yerleştirilmesidir. DKV’ların en az radyasyona maruz kalma ile doğru ve hızlı bir şekilde yerleştirilmesi çok önemlidir. Bu çalışmada, tibia kırıklarında İMÇ ile osteosentez uygulanan hastalarda ameliyat süresi ve radyasyon maruziyeti açısından iki farklı distal kilitleme yönteminin sonuçlarını karşılaştırmayı amaçladık.GEREÇ VE YÖNTEM: İleriye yönelik yapılan bu çalışmada toplamda 72 hastadan dahil etme ve dışlama kriterlerini karşılayan 56 olgunun sonuçları değerlendirildi. Hastalar distal vidalama yöntemine göre iki gruba ayrıldı. Grup-1 (n=29) distal kilitleme için serbest el tekniği (SET) kullanılan hastaları, Grup-2 (n=27) distal kilitleme için elektromanyetik yönlendirme sistemi (EMYS) kullanılan hastaları içeriyordu. Hastaların demografik ve tıbbi bilgileri, ameliyat süreleri, kanama miktarları, toplam floroskopi süreleri, distal kilitleme için geçen süreler, maruz kalınan radyasyon dozu ölçümleri, distal vida kilitleme için teşebbüs sayıları, hatalı vida yerleşimleri, komplikasyonlar ve takip süreleri kaydedildi. Gruplar demografik veriler ve klinik sonuçlar açısından karşılaştırıldı.BULGULAR: Gruplar arasında cinsiyet ve taraf açısından istatistiksel olarak anlamlı fark yoktu (sırasıyla, p=0.928 ve p=0.432). Grup 1’deki yaş ortalaması Grup-2’den daha yüksekti ve fark istatistiksel olarak anlamlı idi (p=0.012). Ancak, Grup-1’de hastanede kalış süresi açısından istatistiksel olarak anlamlı bir fark yoktu (p=0.140). Diğer taraftan Grup-2’de distal atım sayısı, floroskopi süresi, etkili radyasyon dozu ve operasyon süresi Grup-1’e göre daha düşüktü, ancak bu fark istatistiksel olarak anlamlı değildi (sırasıyla, p=0.057, 0.073, 0.058 ve 0.056). Grup-1’deki üç olguda ve Grup-2’deki iki olguda ilk denemede distal kilitlemede başarısızlıkla karşılaşıldı. Her iki grupta bir hastada aseptik kaynamama gözlendi.TARTIŞMA: Hem SET hem de EMYS distal vidalama tekniği, distal kilitleme için oldukça etkili yöntemlerdir. Ameliyat süresi, floroskopi süresi ve radyasyona maruz kalma benzerdir. Geleneksel İMÇ uygulamalarındaki distal kilitlemelerde, etkili, kolay ve ucuz olduğu için SET tercih edilebilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Aslan A, KONYA M, Gülcü A, SARGIN A (2020). Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. , 280 - 286. 10.14744/tjtes.2020.94490
Chicago	Aslan Ahmet,KONYA Mehmet Nuri,Gülcü Anıl,SARGIN Assoc.Prof. Serdar Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. (2020): 280 - 286. 10.14744/tjtes.2020.94490
MLA	Aslan Ahmet,KONYA Mehmet Nuri,Gülcü Anıl,SARGIN Assoc.Prof. Serdar Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. , 2020, ss.280 - 286. 10.14744/tjtes.2020.94490
AMA	Aslan A,KONYA M,Gülcü A,SARGIN A Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. . 2020; 280 - 286. 10.14744/tjtes.2020.94490
Vancouver	Aslan A,KONYA M,Gülcü A,SARGIN A Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. . 2020; 280 - 286. 10.14744/tjtes.2020.94490
IEEE	Aslan A,KONYA M,Gülcü A,SARGIN A "Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study." , ss.280 - 286, 2020. 10.14744/tjtes.2020.94490
ISNAD	Aslan, Ahmet vd. "Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study". (2020), 280-286. https://doi.org/10.14744/tjtes.2020.94490

APA	Aslan A, KONYA M, Gülcü A, SARGIN A (2020). Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. Ulusal Travma ve Acil Cerrahi Dergisi, 26(2), 280 - 286. 10.14744/tjtes.2020.94490
Chicago	Aslan Ahmet,KONYA Mehmet Nuri,Gülcü Anıl,SARGIN Assoc.Prof. Serdar Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.2 (2020): 280 - 286. 10.14744/tjtes.2020.94490
MLA	Aslan Ahmet,KONYA Mehmet Nuri,Gülcü Anıl,SARGIN Assoc.Prof. Serdar Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.2, 2020, ss.280 - 286. 10.14744/tjtes.2020.94490
AMA	Aslan A,KONYA M,Gülcü A,SARGIN A Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 280 - 286. 10.14744/tjtes.2020.94490
Vancouver	Aslan A,KONYA M,Gülcü A,SARGIN A Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 280 - 286. 10.14744/tjtes.2020.94490
IEEE	Aslan A,KONYA M,Gülcü A,SARGIN A "Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.280 - 286, 2020. 10.14744/tjtes.2020.94490
ISNAD	Aslan, Ahmet vd. "Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study". Ulusal Travma ve Acil Cerrahi Dergisi 26/2 (2020), 280-286. https://doi.org/10.14744/tjtes.2020.94490