The Effect of C-Arm Mobility and Field of Vision on Radiation Exposure in the Treatment of Proximal Femoral Fractures: A Randomized Clinical Trial

OBJECTIVES: To examine the effect of fluoroscopy devices with different sizes of image intensifier and C-arm maneuverability on operating time, fluoroscopy time, radiation dose and reduction, and fixation quality at intertrochanteric femoral fractures. DESIGN: Single-center, randomized, prospective study. SETTING: Academic Level I trauma hospital. PATIENTS AND INTERVENTION: 34 patients treated with cephalomedullary nailing for a stable, intertrochanteric proximal femur fracture (OTA A1). MAIN OUTCOME MEASUREMENT: The total working time of the fluoroscopy device, the dose-area product (DAP), operating time, reduction quality (cortical continuity, symmetrical collodiaphyseal angle, and shortness), and fixation quality (Bosworth quadrants, the tip-apex distance, TAD). RESULTS: There were no cases of poor reduction; also the placement of the blade was optimal for 14 patients and suboptimal in 3 patients in each group. Superior-posterior placement of the blade or TAD > 25 mm was not seen in any patient. Total operating time was significantly shorter when using device A compared to the use of device B (20.1 ± 3.4 mins versus 25.3 ± 5.4 mins, p < 0.001). Total radiation time was significantly shorter with device A compared to the use of device B (58.1 ± 19.4 secs versus 98.9 ± 55.4 secs, p = 0.008). The measured radiation dose was lower with the use of device A compared to device B (3.5 ± 1.2 Gy·cm(2) versus 7.3 ± 4.5 Gy·cm(2), p = 0.002). CONCLUSION: Physical properties of fluoroscopy devices used during the fixation of intertrochanteric fractures could yield significant differences in operating times and the radiation dose while having comparable clinical results.