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Intraoperative ultrasound-guided reduction of femoral shaft fractures using intramedullary nailing: a technical note

  • Zhao Zhe
  • Zhu Jianjin
  • Song Fei
  • He Dawei
  • Deng Jiuzheng
  • Chen Fang
  • Pan Yongwei
Orthopaedic Surgery
  • 8 Downloads

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.

Keywords

Intraoperative ultrasound Femoral fractures Reduction Intramedullary nailing 

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

402_2018_3085_MOESM1_ESM.avi (547 kb)
Supplementary material 1 (AVI 547 KB)
402_2018_3085_MOESM2_ESM.avi (1.3 mb)
Supplementary material 2 (AVI 1358 KB)

References

  1. 1.
    Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17(5):296–305CrossRefPubMedGoogle Scholar
  2. 2.
    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 CrossRefPubMedGoogle Scholar
  3. 3.
    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 CrossRefPubMedGoogle Scholar
  4. 4.
    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 CrossRefGoogle Scholar
  5. 5.
    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 CrossRefPubMedGoogle Scholar
  6. 6.
    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):368–371CrossRefPubMedGoogle Scholar
  7. 7.
    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 CrossRefPubMedGoogle Scholar
  8. 8.
    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 CrossRefPubMedGoogle Scholar
  9. 9.
    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 CrossRefPubMedGoogle Scholar
  10. 10.
    Durston W, Swartzentruber R (2000) Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med 18(1):72–77CrossRefPubMedGoogle Scholar
  11. 11.
    Degreif J, Wenda K (1998) Ultrasound-guided spinal fracture repositioning. Surg Endosc 12(2):164–169CrossRefPubMedGoogle Scholar
  12. 12.
    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) CrossRefPubMedGoogle Scholar
  13. 13.
    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 CrossRefPubMedGoogle Scholar
  14. 14.
    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 CrossRefPubMedGoogle Scholar
  15. 15.
    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 CrossRefPubMedGoogle Scholar
  16. 16.
    Tornetta P III, Ritz G, Kantor A (1995) Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma 38(2):213–219CrossRefPubMedGoogle Scholar
  17. 17.
    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):90–95CrossRefPubMedGoogle Scholar
  18. 18.
    Rüedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management, 2nd edn. Thieme, StuttgartGoogle Scholar
  19. 19.
    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 CrossRefPubMedGoogle Scholar
  20. 20.
    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 CrossRefPubMedGoogle Scholar
  21. 21.
    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 CrossRefPubMedGoogle Scholar
  22. 22.
    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 CrossRefPubMedGoogle Scholar
  23. 23.
    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 CrossRefPubMedGoogle Scholar
  24. 24.
    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 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Zhao Zhe
    • 1
  • Zhu Jianjin
    • 1
  • Song Fei
    • 1
  • He Dawei
    • 1
  • Deng Jiuzheng
    • 1
  • Chen Fang
    • 2
  • Pan Yongwei
    • 1
  1. 1.Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical MedicineTsinghua UniversityBeijingChina
  2. 2.Department of Computer Science and EngineeringNanjing University of Aeronautics and AstronauticsNanjingChina

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