Development of a Contextually Adapted Intraoperative Fluoroscopy Protocol for Fracture Fixation in Nigerian Veterinary Teaching Hospitals

Intraoperative fluoroscopy enables real-time radiographic visualization during fracture fixation, significantly improving implant placement accuracy and reducing revision surgery rates. However, no standardized fluoroscopy protocol adapted to the equipment constraints, species diversity, and workforce realities of Nigerian veterinary teaching hospitals exists. This doctoral study develops, implements, and evaluates a contextually adapted intraoperative fluoroscopy protocol for fracture fixation at veterinary teaching hospitals in Ibadan, Enugu, and Maiduguri between 2021 and 2024. The protocol development process involved systematic review of 56 international fluoroscopy-assisted orthopedic surgery studies, stakeholder needs assessment interviews with 24 surgical faculty and residents, and iterative protocol refinement through a structured expert panel. A protocol validation study enrolled 80 dogs and cattle with long bone fractures randomized to fluoroscopy-assisted versus conventional open fracture fixation. Primary outcomes included implant malposition rate, intraoperative correction rate, surgical duration, and 12-week radiographic healing assessment. Fluoroscopy-assisted fixation significantly reduced implant malposition rates from 28% to 9% and resulted in 22% fewer intraoperative implant adjustments. Radiation dose optimization measures incorporated into the protocol maintained mean staff radiation doses well within regulatory limits across all monitored procedures. The contextually adapted protocol achieved equivalent radiation safety performance to international benchmarks despite using locally available equipment types. This doctoral contribution provides the first Nigeria-specific fluoroscopy protocol for veterinary fracture surgery, filling a critical methodological gap and supporting improved orthopedic surgical outcomes through evidence-based real-time imaging integration. Keywords: intraoperative fluoroscopy, fracture fixation, protocol development, veterinary orthopedics, Nigeria.