C-arm X-ray fluoroscopy with different projection angles in the evaluation of "in-out-in" posterosuperior screws during percutaneous internal fixation of femoral neck fractures
Zhou Xuefeng1,2, Yang Jiazhao1, Li Li1, Xu Lei1, Wang Xujin1, Fang Shiyuan1
1Department of Traumatic Orthopedics, the First Affiliated Hospital of University of Science and Technology of China (USTC), Anhui Provincial Hospital, Hefei 230001, China; 2Graduate School of Wannan Medical College, Wuhu 241002, China
Abstract：Objective This study was performed to explore the accuracy of C-arm X-ray fluoroscopic images at different projection angles in the evaluation of in-out-in (IOI) posterosuperior screws during percutaneous internal fixation of femoral neck fractures. Methods Six Synbone standard models of proximal femur artificial bone were selected. Then, three 2.5-mm guide pins were placed into the femoral neck according to the same method by simulating percutaneous inverted triangular hollow screw fixation, of which the posterosuperior one was intentionally designed as IOI. C-arm X-ray machine was used to observe the penetration of the IOI guide pin at the posterosuperior side of the femoral neck through the cortex on C-arm X-ray fluoroscopic images at different projection positions: standard adem position and lateral fluoroscopic images and axial fluoroscopy; fluoroscopy after dynamic rotation of the operating bed at a certain angle to the horizontal plane; and sequential rotation fluoroscopy of the C-arm X-ray. Results The standard anteroposterior and lateral fluoroscopic images of the six models showed that the three guide pins were completely located in the femoral neck, and no perforation of the cortex was observed. Axial perspective of the femoral neck showed that the IOI guide pin obviously pierced through the cortex. When the operating bed was rotated at approximately 20° counterclockwise, the fluoroscopy showed that the IOI guide pin penetrated the cortex. When the C-arm image intensifier was sequentially rotated at 40°, the IOI guide pin penetrated the cortex and showed an IOI state in the femoral neck. Conclusion The adem position and lateral fluoroscopic images showed a false appearance in the evaluation of the IOI posterosuperior screws during percutaneous internal fixation of femoral neck fractures. Images with 40° sequential rotation fluoroscopy clearly showed the IOI posterosuperior screws of the femoral neck.
周雪锋, 杨家赵, 李黎, 徐磊, 王叙进, 方诗元. C臂X线机不同投射角度透视对股骨颈骨折经皮内固定后上方in-out-in螺钉的评估[J]. 中华解剖与临床杂志, 2022, 27(10): 679-683.
Zhou Xuefeng, Yang Jiazhao, Li Li, Xu Lei, Wang Xujin, Fang Shiyuan. C-arm X-ray fluoroscopy with different projection angles in the evaluation of "in-out-in" posterosuperior screws during percutaneous internal fixation of femoral neck fractures. Chinese Journal of Anatomy and Clinics, 2022, 27(10): 679-683.
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2022, Vol. 27 
