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New Mini C-Arm Technique Reduces Contamination Risk During Surgical Fluoroscopy

Key findings

  • No specific technique has ever been described for proper draping of a mini C-arm, even though fluoroscopy is commonly used during orthopedic surgery
  • Orthopedic surgeons at Massachusetts General Hospital have developed a simple, low-cost approach that uses standard available draping materials to cover the flat plate of the mini C-arm during foot and ankle surgery
  • This method for mini C-arm preparation is suitable for use in other orthopedic subspecialties

For fluoroscopy during orthopedic surgery, the mini C-arm is frequently used because it allows the surgeon to maneuver the machine easily to obtain the desired images. However, continuous manipulation of the mini C-arm introduces the means to contaminate the sterile surgical field, particularly during prolonged procedures.

The risk of contamination is especially pronounced in foot and ankle procedures, where sharp objects, such as wires that protrude from the incision, need to be examined fluoroscopically for accurate placement. Yet no specific technique has ever been described for proper draping of the mini C-arm.

To prevent the risk of penetration and resultant contamination through mini C-arm draping, Clinical Fellow in Orthopedic Surgery Bonnie Y. Chien, MD, and Christopher W. DiGiovanni, MD, chief of the Foot and Ankle Center at Massachusetts General Hospital, and colleagues have developed a simple approach to covering the flat detector portion of the mini C-arm. They describe the procedure in Foot & Ankle Specialist.

The Technique

1. With standard sterile plastic draping, cover the entire portion of the mini C-arm that may be handled intraoperatively

2. Fold two or three standard sterile blue towels to appropriate size and stack them over the flat detector portion of the mini C-arm

3. Wrap a six-inch stockinette tightly over the towels and flat detector, like a sock, to minimize contact with unsterile areas

Advantages and a Caveat

Dr. DiGiovanni has used this low-cost draping technique extensively and has observed minimal penetration that would suggest contamination. The draping also provides cushioning to protect the surface of the flat plate. Surgeons should remain alert that the bottom part of the "C" of the mini C-arm remains unsterile.

The mini C-arm preparation is suitable for use in other orthopedic subspecialties, the authors note.

Learn more about the Foot & Ankle Center at Mass General

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