{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T13:22:27Z","timestamp":1782307347571,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Rotational malalignment (\u2265\u200910\u00b0) is a frequent pitfall of intramedullary-nailing of tibial shaft fractures. This study aimed to develop an intraoperative fluoroscopy protocol, coined \u2018C-Arm Rotational View (CARV)\u2019, to significantly reduce the risk for rotational malalignment and to test its clinical feasibility.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cadaver and clinical feasibility study was conducted to develop the CARV-technique, that included a standardized intraoperative fluoroscopy sequence of predefined landmarks on the uninjured and injured leg in which the rotation of the C-arm was used to verify for rotational alignment. A mid-shaft tibia fracture was simulated in a cadaver and an unlocked intramedullary-nail was inserted. Random degrees of rotational malalignment were applied using a hand-held goniometer via reference wires at the fracture site. Ten surgeons, blinded for the applied rotation, performed rotational corrections according to (1) current clinical practice after single-leg and dual-leg draping, and (2) according to the CARV-protocol. The primary outcome measure was the accuracy of the corrections relative to neutral tibial alignment. The CARV-protocol was tested in a small clinical cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In total, 180 rotational corrections were performed by 10 surgeons. Correction according to clinical practice using single-leg and dual-leg draping resulted in a median difference of, respectively, 10.0\u00b0 (IQR 5.0\u00b0) and 10.0\u00b0 (IQR 5.0\u00b0) relative to neutral alignment. Single-leg and dual-leg draping resulted in malalignment (\u226510\u00b0) in, respectively, 67% and 58% of the corrections. Standardized correction using the CARV resulted in a median difference of 5.0\u00b0 (IQR 5.0\u00b0) relative to neutral alignment, with only 12% categorized as malalignment (\u226510\u00b0). The incidence of rotational malalignment after application of the CARV decreased from 67% and 58% to 12% (<jats:italic>p<\/jats:italic>\u2009=\u2009\u2009&lt;0.001). Both consultants and residents successfully applied the CARV-protocol. Finally, three clinical patients with a tibial shaft fracture were treated according to the CARV-protocol, resulting all in acceptable alignment (&lt;10\u00b0) based on postoperative CT-measurements.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study introduces an easy-to-use and clinically feasible standardized intraoperative fluoroscopy protocol coined \u2018C-arm rotational view (CARV)\u2019 to minimize the risk for rotational malalignment following intramedullary-nailing of tibial shaft fractures.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-02038-2","type":"journal-article","created":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T06:02:51Z","timestamp":1659160971000},"page":"2329-2336","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures: introduction of the \u2018C-Arm Rotational View (CARV)\u2019"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-6058","authenticated-orcid":false,"given":"Nils Jan","family":"Bleeker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job N.","family":"Doornberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaj","family":"ten Duis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"El Moumni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge H. 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