Rib osteosynthesis is a safe and effective treatment and leads to a significant reduction of trauma associated pain.

PURPOSE: The usefulness of chest wall stabilization after blunt chest wall trauma with unstable rib fractures has recently been intensely discussed. Thereby, the surgical approach seems to influence outcome, mortality and the long-term complication rate including chronic chest pain, thoracic deformity and quality of life. Here, we present the outcome after surgical stabilization of unstable rib fractures using intramedullary splints and plate osteosynthesis. METHODS: n = 50 patients were enrolled in this trial. Surgical stabilization was performed using intramedullary splints and/or plate osteosynthesis. Video-assisted thoracoscopy was performed in all patients for the inspection of the thoracic cavity and to exactly localize the fractured ribs. The pre- and postoperative pain course was documented using the visual analog scale. RESULTS: A total of n = 50 patients (10 females, mean age 63 years) were included into the analysis. All patients presented with traumatic serial rib fractures with a mean of 3 fractured ribs (range 2-8 ribs) and an unstable thorax wall. Rib osteosynthesis was performed using intramedullary splints (n = 17 patients), locking plates (n = 17 patients), or a combined use of both procedures (n = 16 patients). Mean operating time was 80 min (31-161 min). No major complications were seen intra- and postoperatively. Mean hospital stay was 8 ± 2 days (2-21 days). In all patients, excellent chest wall stability was achieved. Moreover, a significant reduction of pain was observed (2.6 ± 0.3 postoperatively vs. 8 ± 1.15 preoperatively, p < 0.0001) already during the hospital stay. CONCLUSIONS: Rib osteosynthesis is a safe and effective treatment option for patients with unstable rib fractures after blunt chest wall trauma. It leads to a significant reduction of the trauma-associated pain caused by the rib fractures and supports a quick recovery of the patients.

Radiation Exposure of Anaesthetists Visualised by Real-time Dosimetry.

BACKGROUND: Chronic exposure to occupational ionising radiation is seen as one reason for elevated cancer prevalence. OBJECTIVE: The aim of this retrospective study was to evaluate radiation exposure of anaesthetists by real-time dosimetry. METHODS: Data of 296 patients were analyzed. Ten types of trauma operation procedures including osteosynthesis of upper and lower extremity fractures and minimally invasive stabilisation of traumatic and osteoporotic vertebral fractures were accomplished. Evaluation was performed by an occupational dosimetry system, which visualises anaesthetists radiation exposure feedback compared to surgeons in real-time. RESULTS: A significantly lower radiation exposure to anaesthetists compared to surgeons was observed in four types of operative procedures: Plate fixation of proximal humerus fractures, osteosynthesis of proximal femoral fractures, stabilisation of traumatic and osteoporotic vertebral fractures. In four types of operations (plate osteosynthesis of proximal humeral, distal radial and tibial fractures and intramedullary nailing of the clavicle), anaesthetists` amount of radiation exceeded one-third of the surgeons' exposure, especially if the C-arm tube was positioned close to the anaesthetists work station at the patients' head. CONCLUSION: By using the occupational radiation dose monitoring system, radiation exposure to anaesthetists was visualised in real-time during trauma operations. Radiation exposure of anaesthetists depends on the type of operation and the position of the C-arm. The system may help to increase anaesthetists` awareness concerning radiation exposure and to enhance compliance in using radiation protection techniques.

Evaluation of the new C-arm guiding system ClearGuide® in an orthopaedic and trauma operating theatre.

BACKGROUND: The objective was to evaluate whether the new intraoperative C-arm guiding system ClearGuide® (CG) reduces radiation exposure of the staff in an Orthopaedic and Trauma operation theatre. METHODS: Data of 95 patients CG was used were retrospectively compared using matched-pair analysis with controls without CG. Radiation dose (RD), fluoroscopic time (FT) and operation time (OT) were analysed in ten types of operative procedures. RESULTS: Use of CG led to a significant reduction (p ≤ 0.05) of the RD in intramedullary nailing and plate fixation of femoral shaft fractures as well as plating of tibia shaft fractures. Concerning FT, use of CG led to a significant reduction (p ≤ 0.05) while performing kyphoplasties and plate fixation of femoral shaft fractures. Regarding OT, no statistical significance was observed. CONCLUSIONS: CG as a simple, reproducible and intuitive communication tool for C-arm guidance reduces intraoperative staff radiation exposure especially while fixation of long bone fractures and in spine surgery.

Fluoroscopy-based computer-assisted navigation for implant placement and hip resurfacing arthroplasty in the proximal femur: the zero-dose C-arm navigation approach.

Abstract In the proximal femur, a high accuracy of implant placement reduces the risk of mechanical failure. We have tested a new computer-assisted planning and navigation system based on two-dimensional fluoroscopy using the so-called zero-dose C-arm navigation approach to optimise implant placement in fracture fixation and hip resurfacing. The aim of this review is to compare the results of this system with the current literature. Use of the novel system enables a minimally invasive approach to the hip and results in enhanced accuracy of implant placement compared with conventional techniques. Its precision is comparable to navigation systems currently in the market. The new system reduces irradiation but requires more operation time in comparison with established navigation systems. We believe zero-dose C-arm navigation can effectively be used to support surgeons in modern orthopaedic and trauma surgery departments, and can sufficiently serve the demands of both sections, especially at a time focusing on saving costs.

Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study.

PURPOSE: Medial femoral neck fractures are common, and closed reduction and internal fixation by three cannulated screws is an accepted method for the surgical treatment. Computer navigation for screw placement may reduce fluoroscopy time, the number of guidewire passes and optimise screw placement. METHODS: In the context of a sawbone study, a computer-assisted planning and navigation system based on 3D-imaging for guidewire placement in the femoral neck was tested to improve screw placement. Three screws were inserted into 12, intact, femoral sawbones using the conventional technique and into 12, intact, femoral sawbones guided by the computer-based navigation system. Guidewire and subsequent screw placement in the femoral neck were evaluated. RESULTS: Use of the navigation system resulted in a significant reduction of the number of drilling attempts (p≤0.05) and achieved optimised accuracy of implant placement by attaining significantly better screw parallelism (p≤0.05) and significantly enlarged neck-width coverage by the three screws (p≤0.0001). Computer assistance significantly increased the number of fluoroscopic images (p≤0.001) and the operation time (p≤0.0001). CONCLUSIONS: Three-dimensional computer-assisted navigation improves accuracy of cannulated screw placement in femoral neck while increasing the number of fluoroscopic images and operation time. Additional studies including fractured sawbones and cadaver models with the goal of reducing operation time are indispensable before introduction of this navigation system into clinical practice.