A retrospective comparative study of intraoperative fluoroscopy and postoperative radiography for measuring mounting parameters of the taylor spatial frame in tibial fractures.

objectiveReliable measurement of mounting parameters (MP) is crucial for effective deformity correction using the Taylor Spatial Frame (TSF). Intraoperative fluoroscopy (IF) allows real-time parameter acquisition but is technically demanding, requiring precise projection angles; otherwise, projection distortion may occur. In contrast, postoperative radiographic measurement is simpler but prone to parallax errors inherent to two-dimensional imaging. The consistency between these two methods and their respective effects on correction efficiency remains unclear. Therefore, this study aims to compare the consistency of IF with postoperative radiography (PR) for measuring the MP of TSFs and to evaluate their clinical impact.

methodsThis single-center retrospective cohort study included 86 patients aged 20-60 years with tibial fractures who underwent TSF treatment between May 2021 and May 2024. Based on the measurement method for MP, the patients were divided into two groups: an IF group (n = 41, measured via IF) and a PR group [n = 45, measured via postoperative standard anteroposterior (AP) and lateral (LAT) radiographs]. Primary outcome measures included measurement of operation time, surgical time, number of electronic prescriptions, and fracture reduction time (interval from the execution of the first prescription to imaging-confirmed satisfactory reduction). Secondary outcome measures included final radiological outcomes (AP and LAT angulation and translation), fracture healing time, and Johner-Wruhs functional scores at the study endpoint. The intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency of parameters between two independent observers, and the satisfactory reduction rate of the initial prescription was compared between the two groups.

resultsAll 86 patients completed the follow-up, with a mean follow-up of 28.1 months. The two groups were comparable at baseline for age, sex, injury mechanism, AO/OTA classification, and Gustilo-Anderson classification (all P > 0.05). Regarding consistency, the inter-observer consistency in the IF group appeared higher than that in the PR group based on descriptive comparison of 95% CIs (ICC: 0.92 vs. 0.81), and parallax errors caused by suboptimal radiographic positioning were the primary reason for measurement inconsistency in the PR group. In terms of intraoperative workflow, the software-based measurement time in the PR group was shorter than that in the IF group (11.8 ± 2.4 min vs. 18.4 ± 2.1 min). Because the measurement process was shifted to the postoperative period, the total surgical time was significantly shorter than that in the IF group (73.7 ± 6.2 min vs. 92.1 ± 7.2 min), with both differences being statistically significant (P < 0.001). Regarding reliability and reduction efficiency, the IF group required fewer electronic prescriptions (median [IQR]: 1 [1, 2] vs. 2 [1, 2], P = 0.003) and had a shorter fracture reduction time (3.9 ± 0.7 d vs. 4.8 ± 0.8 d, P < 0.001); although the satisfactory reduction rate after a single prescription was numerically higher in the IF group than in the PR group (68.3% vs. 57.8%), the difference was not statistically significant (P = 0.314). No statistically significant differences were observed between the two groups in final radiological alignment, fracture healing time (25.2 ± 3.1 weeks vs. 24.4 ± 2.7 weeks), or the excellent and good rate of Johner-Wruhs functional scores (90.2% vs. 88.9%) (all P > 0.05).

conclusionIF appeared to offer higher inter-observer consistency for MP measurement versus PR, though this finding should be interpreted cautiously given the retrospective design. IF was associated with significantly fewer electronic prescriptions and shorter fracture reduction time, suggesting improved correction efficiency. Although postoperative radiographic measurement is simpler to perform and involves shorter intraoperative time for parameter acquisition, it is inferior to IF in reduction efficiency. However, both methods can ultimately achieve satisfactory radiological alignment, fracture healing time, and functional prognosis, yielding comparable endpoint outcomes. Therefore, the clinical selection of measurement strategies should balance efficiency demands and time costs: for complex cases requiring high reduction precision, IF may be the optimal choice; whereas for specific patients sensitive to surgical time, postoperative radiographic measurement can also serve as a safe and effective alternative. However, the lack of quantitative radiation dose data in the IF group is a key limitation of this study, and future research should include dosimetry to enable a more complete comparison.