Background: Pediatric supracondylar humerus fractures have traditionally been reduced and fixed with conventional C-arm (CCA) fluoroscopy guidance. With the increase in popularity of the newer mini C-arm (MCA) system within other fields of surgery due to its ease of use and lower radiation emission, the same adoption should be explored in pediatric orthopedic surgeries. The purpose of this study is to compare the MCA and CCA primarily in reduction and fixation outcomes and secondarily in other perioperative parameters.
Methods: Retrospective analysis of 193 patients who underwent surgical fixation for displaced supracondylar humerus fractures. 44 and 149 cases were performed with the MCA and CCA respectively. Baumann's angle and the intersection of anterior humeral line (AHL) were assessed on postoperative anterior posterior and lateral radiographs and adequate reduction was defined by an angle between 64 and 81˚, and AHL intersecting middle third of the capitellum. Surgical time, fluoroscopy duration, number of images and radiation exposure were obtained from the surgical notes.
Results: Amongst the CCA cases, there were greater satisfactory coronal plane reduction (p < 0.05), while no difference in sagittal plane accuracy (p > 0.05) was seen. In MCA group, longer surgical (p < 0.05) and fluoroscopy times (p < 0.05), and greater number of shots (p < 0.05) was noted. However overall radiation exposure in the MCA group was still lower (p < 0.05).
Conclusion: The MCA system is potentially less accurate in coronal plane reduction and more challenging to use. However, pitfalls can easily be avoided. Usage should be advocated as overall radiation exposure can be reduced.
Level of evidence: Level III retrospective comparative study.
Keywords: Fluoroscopy; Humerus supracondylar fractures; Image intensifier; Mini C-arm; Paediatric fractures; Percutaneous fixation; Quality improvement; Radiation exposure; Radiation safety; Upper limb.
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