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Role of mini C-arm in orthopedic emergency department, Karachi, Pakistan "save time, money and radiation exposure".

Ranjeet Kumar, Muhammad Muzzammil, Kiran Maqsood, Anisuddin Bhatti

Objectives: To determine role of mini C-Arm in orthopedic Emergency department of tertiary care hospital in Karachi, Pakistan.

Method: A retrospective cohort study was conducted in accident &emergency department of tertiary care hospital in Karachi, JPMC from 15 Nov 2015 to 15 May 2016. 500 forearm and wrist displaced fractures were treated under sedation with closed manipulation and casting in accident & emergency Department and the data was compared with historical controls. In 250 patients fractures were reduced and assessed with a mini-c-arm device while in 250 patients manipulation results were evaluated with radiographs. Patients aged between 2yrs to 60yrs with uncomplicated, isolated fractures were included in the study after informed written consent. .Subjects eligible for the study were randomly divided in two groups. Group 1 includes patients in which mini-c-arm fluoroscopy was used to check manipulation results (case group) and in Group 2 patients we used post reduction x-rays (control group).Pre- and post-reduction radiographs were obtained in each patient.

Results: Significant improvement in reduction quality seen in fractures undergoing closed reduction with mini c-arm assistance, had a (average angulation [and standard deviation], 7° ± 3° vs. 8 ± 5°; p = 0.02), significant decrease in repeated manipulations and need for subsequent operative intervention. (2% of 250 fractures of control group vs. 8.4% of 250 fractures of historical group; p ≤ 0.0003), and a decrease in hazardous radiation exposure to the patients (mean, 13.0 ± 11.3 mrem vs. 48.0 ± 11.7 mrem).The average decrease in orthopedic consultation time with the use of a mini c-arm (25 ± 12 min vs. 45 ± 20 min, p = 0.003) was observed. Conclusion: With the use of the mini c-arm in closed reduction of forearm and wrist fractures in the accident & emergency department can improve the quality of fracture alignment, decrease in radiation exposure to the patient and decrease in need for repeat fracture reduction or additional procedures. Decrease in average orthopedic consultation time for fracture reduction can also be achieved by Mini-c-arm imaging.