Reducing radiation exposure in intra-medullary nailing procedures: intra-medullary endo-transilluminating (iMET).

The purpose of the study was to reduce the level of radiation exposure during intra-medullary nailing procedures. A visible light source was inserted into the medullary bone cavity in order to detect the distal interlocking screw holes. The light penetrates out of the bone surface, revealing the position of the screw hole, and this allows the subsequent drilling and placing of the interlocking screw to be free of fluoroscopy. Among the 19 consecutive tibia-fracture patients recruited for this study, no repetition of the drilling procedure or insertion of a transverse interlocking screw was needed. The average time to finish the insertion of one distal interlocking screw was 4.1+/-1.8 min. It was extrapolated that 13-41% of previous radiation exposure levels could be saved. The non-fluoroscopic approach thus decreases the health hazards that the patients are experiencing as well as those of the surgical team who need to perform such intra-medullary nailing operations on a routine basis.

[1]  S. Skjeldal,et al.  Interlocking medullary nails — Radiation doses in distal targeting , 2004, Archives of orthopaedic and traumatic surgery.

[2]  C. Krettek,et al.  Experimental study of distal interlocking of a solid tibial nail: radiation-independent distal aiming device (DAD) versus freehand technique (FHT). , 1998, Journal of orthopaedic trauma.

[3]  B. Browner,et al.  Radiation exposure to the surgeon during closed interlocking intramedullary nailing. , 1987, The Journal of bone and joint surgery. American volume.

[4]  R. Dega,et al.  Measurement of the dose of radiation to the surgeon during surgery to the foot and ankle. , 2007, The Journal of bone and joint surgery. British volume.

[5]  A. Welch,et al.  A review of the optical properties of biological tissues , 1990 .

[6]  T. Shope,et al.  Radiation-induced skin injuries from fluoroscopy. , 1996, Radiographics : a review publication of the Radiological Society of North America, Inc.

[7]  Kalid M Abdlslam,et al.  Experimental model for a new distal locking aiming device for solid intramedullary tibia nails. , 2003, Injury.

[8]  L. Nokes,et al.  Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. , 2006, Injury.

[9]  N. Maffulli,et al.  Intramedullary nailing of the femur with an inflatable self-locking nail: comparison with locked nailing , 2003, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[10]  P. Soucacos,et al.  The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures , 2007, Archives of Orthopaedic and Trauma Surgery.

[11]  S Stenzler,et al.  Exposure of the orthopaedic surgeon to radiation. , 1993, The Journal of bone and joint surgery. American volume.

[12]  F. Malkinson.  Radiation injury to skin following fluoroscopically guided procedures. , 1996, Archives of Dermatology.

[13]  C Krettek,et al.  Deformation of femoral nails with intramedullary insertion , 1998, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  T. Dipasquale,et al.  Radiation exposure to the orthopaedic surgical team during fluoroscopy: "how far away is far enough?". , 1997, Journal of orthopaedic trauma.

[15]  S. Silverman,et al.  Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. , 2000, Radiology.

[16]  P M Rommens,et al.  Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. , 1998, Injury.

[17]  Lynn Rill,et al.  Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures. , 2005, The Journal of bone and joint surgery. American volume.

[18]  C. Krettek,et al.  A new mechanical aiming device for the placement of distal interlocking screws in femoral nails , 1998, Archives of Orthopaedic and Trauma Surgery.

[19]  S Tyropoulos,et al.  A new distal targeting device for closed interlocking nailing. , 2001, Injury.

[20]  D Pardiwala,et al.  The AO distal locking aiming device: an evaluation of efficacy and learning curve. , 2001, Injury.

[21]  Z. Gugala,et al.  Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques. , 2001, Injury.

[22]  T D Bunker,et al.  Radiation dosage during AO locking femoral nailing. , 1988, Injury.

[23]  S. Jacques,et al.  Optical reflectance and transmittance of tissues: principles and applications , 1990 .

[24]  L. Bone,et al.  Treatment of tibial fractures by reaming and intramedullary nailing. , 1986, The Journal of bone and joint surgery. American volume.

[25]  Brian D Giordano,et al.  Exposure to direct and scatter radiation with use of mini-c-arm fluoroscopy. , 2007, The Journal of bone and joint surgery. American volume.

[26]  S. Madan,et al.  Radiation exposure to surgeon and patient in intramedullary nailing of the lower limb. , 2002, Injury.

[27]  E L Siegel,et al.  Severe skin reactions from interventional fluoroscopy: case report and review of the literature. , 1999, Radiology.

[28]  C Krettek,et al.  The deformation of small diameter solid tibial nails with unreamed intramedullary insertion. , 1997, Journal of biomechanics.

[29]  Gerhard B. G. Künstscher.  The Kuntscher method of intramedullary fixation. , 1958 .

[30]  Ivan Zuna,et al.  Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective, controlled clinical study. , 2004, Injury.

[31]  F. Mettler,et al.  Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. , 2001, AJR. American journal of roentgenology.

[32]  E. Brug,et al.  [Insertion of distal screws in interlocking nailing using a new free-hand control device]. , 1989, Der Unfallchirurg.

[33]  Stephen Balter,et al.  Minimizing radiation-induced skin injury in interventional radiology procedures. , 2002, Radiology.

[34]  P. Reynders,et al.  Interlocking nail: a practical aiming device for distal screw insertion. , 1990, Acta orthopaedica Belgica.

[35]  S M Perren,et al.  Development and testing of a new self-locking intramedullary nail system: testing of handling aspects and mechanical properties. , 2000, Injury.

[36]  A. Alho,et al.  Interlocking intramedullary nailing in femoral shaft fractures. A report of forty-eight cases. , 1985, The Journal of bone and joint surgery. American volume.

[37]  F. Mettler,et al.  Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. , 2001, AJR. American journal of roentgenology.

[38]  R J Medoff,et al.  Insertion of the distal screws in interlocking nail fixation of femoral shaft fractures. Technical note. , 1986, The Journal of bone and joint surgery. American volume.

[39]  D. Wiss,et al.  Comminuted and Rotationally Unstable Fractures of the Femur Treated with an Interlocking Nail , 1986, Clinical orthopaedics and related research.