Fluoroscopic screening results in radiation exposure of medical personnel. The estimate of maximum scatter radiation exposure to the surgeon for 50 PCNL procedures a year did not exceed 10 mGy. This amount is less than 2% of permissible annual limits of equivalent dose to the extremities. Medical personnel should be aware of scatter radiation risks and minimize radiation exposure when involved in fluoroscopic screening procedures.

Systemic FactorsDiabetes Cigarette smoking Alcohol Osteoporosis Nonsteroidal anti-inflammatory drugs Age Obesity Compliance with weight bearing Local Factors Infection Vascularity and avascular necrosis Soft tissue injury and revision surgery Surgical Factors Mechanical Factors Construct stability Interfragmentary gaps Surgeon FactorsHigh-volume vs. low-volume surgeons foot or ankle. The efficacy of strategies to modify the risk of delayed or failed healing after arthrodesis is also reviewed. PATIENT FACTORS Systemic risk factorsBiological variation of the host and genetic predisposition have been recognized as important factors in bone healing. 31 Comorbidities, including diabetes, rheumatoid arthritis, and smoking, have been postulated to have a negative impact on bone healing. Recently, genomic studies have suggested that variation in host biology may be highly dependent 1031 1032

The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.