Availability, utilization patterns, and challenges of intraoperative C-arm fluoroscopy in orthopedic surgeries: a survey of orthopedic surgeons in Nigeria

BACKGROUND: Intraoperative C-arm fluoroscopy is vital for orthopedic precision, yet its availability in resource-constrained settings like Nigeria remains under-researched. This study assessed the availability, utilization patterns, and barriers to C-arm use among Nigerian orthopedic surgeons. METHODS: A cross-sectional online survey was conducted using convenience and voluntary sampling. The questionnaire evaluated demographics, practice settings, C-arm availability, and barriers. Data were analyzed using SPSS (v.23) with descriptive statistics and Fisher's exact test. RESULTS: Seventy-seven surgeons from 46 hospitals across 25 states participated. While 88.3% (n = 68) reported C-arm availability at their primary workplace, only 44.1% of those with access used it consistently when indicated. Significant disparities in C-arm presence were found across practice settings (p < 0.001) and city types (p = 0.032), with higher reported presence in federal academic and specialist hospitals. Primary barriers to utilization included machine faults and technical staff shortages, compounded by unreliable electricity. Notably, 77.9% (60 out of 77) of respondents reported altering surgical plans due to physical or functional C-arm non-availability. CONCLUSIONS: While C-arm availability is relatively high in federal Nigerian institutions, consistent utilization remains low due to technical failure and personnel shortages. The high rate of altered surgical plans (77.9%) underscores a critical functional gap that compromises orthopedic standards. Policy interventions must prioritize equipment maintenance frameworks and specialized staff training over mere procurement to bridge the disparity between availability and effective intraoperative use.