A Targeting Arm for Interlocking Screws Reduces Radiation Exposure: Results of a Prospective Randomized Controlled Trial
Bibliographic record
Abstract
OBJECTIVES: To compare time, fluoroscopic utilization, and number of misses for placement of far interlocking screws in tibial and femoral nails using a targeting arm (Targeter) versus perfect circle technique (Control). METHODS: . DESIGN: Prospective randomized controlled trial. SETTING: Single-center, large, urban, level 1 trauma center. PATIENT SELECTION CRITERIA: Patients ≥18 years old with a tibia or femur fracture (AO/OTA 31A, 32, or 42) treated with an intramedullary nail from November 2022 to December 2023 were included. OUTCOME MEASURES AND COMPARISONS: The main outcome measures were number of fluoroscopy images taken and average time elapsed to place each far interlocking screw. The far interlocking screws were defined as the screws farthest from the insertion handle. Comparisons were made between the Targeter and Control cohorts in terms of number of fluoroscopy images taken and average time elapsed to place each far interlocking screw, and the number of misses. RESULTS: Thirty-one patients were randomized to Targeter and 31 to Control. There were no significant differences between the Targeter and Control cohorts in patient sex (58.6% vs. 54.5% women, P = 0.75), age (range (20-90 vs. 18-91, mean 52.7 vs. 54.2, P = 0.81), BMI (mean 25.9 vs. 26.2, P = 0.66), AO classification (13.8% vs. 36.4% 31 A, 37.9% vs. 21.2% 32, 48.2% vs. 42.4% 42, P = 0.20), or number of open fractures (13.8% vs. 7.1%, P = 0.67) between the 2 cohorts. For the Targeter group, fewer images were used than Controls for the first (15.0 vs. 22.5, P = 0.002), second (11.5 vs. 18.0, P = 0.006), and combined first and second (25.0 vs. 39.0, P = 0.001) screws. There was no difference between the Targeter and Control cohorts in the time it took to place the first (6.3 vs. 7.3 minutes, P = 0.31), second (5.8 vs. 6.2 minutes, P = 0.63), or combined first and second (11.9 vs. 13.7 minutes, P = 0.63) screws. In the Control cohort, there was 1 missed screw (1.4%, n = 69). In the Targeter cohort, there were 3 missed screws (5.4%, n = 56), a 4-fold increase that did not reach statistical significance ( P = 0.31). CONCLUSIONS: In this prospective randomized controlled trial, a targeting arm decreased the number of fluoroscopic images used for all far interlocking screws as compared with the perfect circle technique without a reduction in time. There was a trend toward increased misses in the Targeter cohort ( P = 0.31). Although the reduction in radiation exposure may have a cumulative beneficial effect during the course of a surgeon's career, the trend of increased misses with the Targeter should be taken into account. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".