Intraoperative Fluoroscopy in Distal Radius Fracture Fixation: Does C-Arm Size Matter?

Abstract Distal radius fractures are among the most common upper extremity injuries, with over 20% managed surgically in the United States. Intraoperative fluoroscopy using either mini or full C-arm machines is essential to ensure proper reduction and fixation application during these operations, yet no prior studies have directly compared these fluoroscopic techniques in this setting. This study aims to evaluate whether one imaging modality provides superior surgical logistics or clinical outcomes. A review was conducted of all surgically managed, isolated distal radius fractures by six fellowship-trained hand surgeons at a Level I trauma center and affiliated locations between September 2020 and March 2024. Data collected included patient demographics, fluoroscopy modality, intraoperative radiation dose, fluoroscopy time, number of images captured, tourniquet time, operative time, and reoperation rate. A total of 468 procedures in 452 patients met inclusion criteria (mean age: 51 years; 64.7% female). Unplanned reoperation rates were identical between groups (4.02%; p = 0.9989). The mini C-arm group had significantly more images (83.61 vs. 56.28; p = 0.0002), longer fluoroscopy time (186.9 vs. 45.97 seconds; p < 0.0001), and higher radiation exposure (21.92 vs. 1.278 mGy; p < 0.0001). Operative and tourniquet times were also significantly longer in the mini C-arm group (117.7 vs. 84.6 minutes and 91.8 vs. 66.6 minutes, respectively; both p < 0.0001). Full C-arm use in distal radius fracture fixation was associated with shorter operative time, lower radiation exposure, and comparable reoperation rates, suggesting it may be a more efficient and safer imaging strategy.