Radiation exposure from fluoroscopy during fixation of hip fracture and fracture of ankle: Effect of surgical experience

Abstract

Background:Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw) and ankle (Weber B) was performed at a district general hospital in the United Kingdom.Materials and Methods:Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed.Results:The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon's surgical experience.Conclusion:The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could significantly reduce the radiation dose and screening time.

Ionising radiation exposure in paediatric trauma

“…This showed that the experience of the operating surgeon is an independent factor for determining radiation exposure to patients for hip fracture fixation. 3 Fluoroscopy use has increased in the field of orthopaedics, and there is also a consideration for the effects of radiation exposure to the surgeon and operating theatre staff. However, this has been discussed in other studies and is not mentioned here.…”

“…2 Radiation exposure during orthopaedic procedures using fluoroscopy is influenced by many factors including the type and difficulty of the procedure, patient position, radiation protection used and the experience of the surgeon. 3 Paediatric patients provide a unique challenge during surgery owing to their size. There is a risk for a severalfold increased radiation exposure due to the large size of the image intensifiers relative to the patient size.…”

The effect of surgical experience on the amount of radiation exposure from fluoroscopy during dynamic hip screw fixation

“…11,12 Botchu and Ravikumar analysed 60 patients with undisplaced intertrochanteric fractures and 60 with isolated lateral malleolar fractures without comminution who underwent fluoroscopically assisted fixation by the same approach and technique. 11 The authors broadly divided the hip and ankle groups depending on the operative experience of the operating surgeon (<3 years, 3-10 years and >10 years).…”

“…11,12 Botchu and Ravikumar analysed 60 patients with undisplaced intertrochanteric fractures and 60 with isolated lateral malleolar fractures without comminution who underwent fluoroscopically assisted fixation by the same approach and technique. 11 The authors broadly divided the hip and ankle groups depending on the operative experience of the operating surgeon (<3 years, 3-10 years and >10 years). They concluded that the experience of the operating surgeon is one of the most important factors 2 SHO = senior house officer; SpR = specialist registrar Figure 1 For the lateral view, the C-arm should be positioned so that the femoral shaft, neck and head are in a straight line (bold lines).…”

“…10 There have been only a few studies, involving low patient numbers, that have specifically investigated the effect of surgical experience on radiation exposure to the operating surgeon during proximal femur fracture fixation. 11,12 Dynamic hip screw (DHS) fixation for proximal femur fractures is one of the most common procedures in trauma that requires the use of intraoperative fluoroscopy. It is also one of the first few procedures that trainees are left to perform unsupervised.…”