Alternative Technique to Reduce Radiation Exposure during Locked Plate Fixation of Distal Radius Fracture; the Plummet as a Targeting Device

Purpose: Radiation exposure from intraoperative fluoroscopy is routinely encountered in orthopedic procedures, especially during distal radius fracture fixation. Prolonged exposure to high-dose radiation is a known risk factor for genetic mutations. This study presents a simple, alternative mechanical targeting device using a plummet that functions as a laser aimer. Methods: A prospective randomized controlled trial was conducted at a single institution involving 42 consecutive patients who underwent locked plate fixation for distal radius fractures and were randomized into two groups. One group underwent fluoroscopic imaging using a plummet as the aiming device, whereas the other group underwent imaging without an aimer. The radiation exposure time, dose, and fluoroscopy accuracy were recorded and analyzed. Results: A total of 42 patients were enrolled, with 21 assigned to the Plummet group and 21 to the Control group. Demographic data and fracture patterns were comparable between the groups. Compared to the Control group, the Plummet group required significantly fewer fluoroscopic images (8.38 vs. 21.86) and demonstrated a higher accuracy of fluoroscopy (99.21% vs. 67.53%). Radiation exposure was also lower in the Plummet group (3.78 vs. 9.98 µSv), with a shorter ionizing radiation exposure time (0.05 vs. 0.13 min). Operative time was also reduced in the Plummet group (51.52 vs. 60.81 min). Conclusions: Compared to the conventional method, the use of a plummet as an aiming device significantly reduced the number of fluoroscopic images, radiation exposure, and operative time, while improving the accuracy of fluoroscopy.