Computed tomography and fluoroscopy versus radiographic guidance for internal fixation of simulated dorsomedial-plantarolateral central tarsal bone fractures in nonracehorses.
Authors: Smanik Lauren E, Selberg Kurt T, Kawcak Christopher E, Stewart Holly L, Goodrich Laurie R
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Accurate screw placement across central tarsal bone (CTB) fractures remains technically challenging, prompting investigation into whether advanced imaging during surgery offers genuine advantages over standard radiographic techniques. Researchers compared CT with fluoroscopy (CT/F) against digital radiography (DR) alone for guiding 4.5 mm cortical screw placement across simulated dorsomedial-plantarolateral CTB fractures in ten equine cadaver pairs, with postoperative CT validation of final screw position. Whilst marker placement took significantly longer with CT/F guidance, overall procedure time was equivalent between groups, and screw positioning accuracy showed no meaningful difference—though CT/F did demonstrate tighter consistency in screw length placement (78.4%–84.0%) compared to the broader range achieved with radiography alone (76.5%–91.2%). The findings suggest that radiographic guidance alone is a viable option for surgical repair of this fracture type, though minor variations in fluoroscopic or radiographic angulation emerged as a notable source of variability in perceived screw placement. For practitioners, this research supports using standard radiographic guidance for intraoperative fixation of dorsomedial-plantarolateral CTB fractures whilst reserving CT imaging for preoperative assessment of fracture configuration and surgical planning rather than real-time intraoperative use.
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Practical Takeaways
- •Digital radiography alone is a suitable and cost-effective alternative to CT/fluoroscopy for guiding screw placement in central tarsal bone fractures, despite longer setup time for CT
- •Small changes in fluoroscopic or radiographic angle significantly affect perceived screw position, so consistent imaging geometry is critical regardless of technique chosen
- •Reserve CT imaging for preoperative fracture characterization and surgical planning rather than intraoperative guidance, as it offers no speed or positioning accuracy advantage during fixation
Key Findings
- •CT and fluoroscopy did not produce faster screw placement than digital radiography alone (p = 0.12 for total procedure time)
- •CT/F resulted in less variability in screw length determination (95% CI 78.4%-84.0% vs 76.5%-91.2% for radiography)
- •CT/F required significantly longer marker placement time (p = 0.001) with no overall speed advantage
- •Both imaging techniques successfully achieved internal fixation of central tarsal bone fractures with equivalent accuracy in screw positioning