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Fluoroscopic marker-based guidance system improves lag screw placement during Gamma nailing of intertrochanteric fractures: A randomized controlled trial.

OBJECTIVES
To determine whether a fluoroscopy-based navigation system would improve tip apex distance (TAD) compared to the conventional technique.


DESIGN
Randomized controlled trial.


SETTING
Level 1 trauma center PATIENTS:: A total of 161 patients were screened for inclusion in the study. After meeting inclusion and exclusion criteria, 31 patients were randomized (n = 18 navigated vs. n = 13 control group), with the patient blinded to the result INTERVENTION:: Fluoroscopy-based navigated guidance of lag screw length and position.


MAIN OUTCOME MEASURES
Average TAD and the proportion of TAD over 25 mm.


RESULTS
TAD was lower in the navigated group compared to the control group (mean = 17.5 mm vs. 24.2 mm; P = 0.0018). No navigated cases exceeded the 25 mm TAD threshold, compared to 39% of conventional cases (P = 0.0076). Navigation resulted in fewer drilling attempts compared to the conventional technique (median = 1 vs. 4 attempts; P < 0.0001). We detected no significant differences in operation time or total number of fluoroscopic images (P > 0.05).


CONCLUSIONS
Fluoroscopy-based computer navigated Gamma nailing for intertrochanteric fractures improved tip-apex distance and reduced the number of drilling attempts without increasing operation time compared to the conventional fluoroscopy-guided technique in a teaching hospital setting.


LEVEL OF EVIDENCE
I.