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Introduction: The increasing use of minimally invasive orthopedic procedures has led to a greater reliance on fluoroscopy, resulting in elevated radiation exposure for surgeons. This study aimed to evaluate the knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in an academic hospital. Understanding radiation safety is crucial to minimize patient exposure and prevent adverse effects on surgeons. Methods: This cross-sectional study was conducted at the Department of Orthopedics of different tertiary care hospitals in Rawalpindi, Pakistan. Data were collected prospectively for two years, and a total of 505 participants, including residents, consultants, and operation theatre assistants, completed a questionnaire. The questionnaire was validated by experts and covered information on fluoroscopy usage, frequency of surgeries, awareness of radiation safety, and protective measures. Ethical approval was obtained, and data were analyzed using SPSS version 26.0. Results: The majority of participants were male (74.1%), and the sample included various ranks of orthopedic surgeons. Only 56.2% of participants were aware of the usage of fluoroscopy, and 40.2% had read some research on the topic. While 44.6% used lead aprons for radiation protection, the usage of other protective measures and dosimeters was limited. The mediation analysis showed an insignificant indirect association between the rank of orthopedic surgeons, number of surgeries performed, and fluoroscopy usage as a mediator. Awareness and reading research on fluoroscopy were significantly associated with radiation protection. Conclusion: The knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in fluoroscopy use need improvement. The findings emphasize the importance of implementing training programs, providing radiation protection devices, and ensuring compliance with safety guidelines.

Extradural hematomas (EDH) and subdural hematomas (SDH) are extra-axial hemorrhages. Acute EDH is often observed in young people after traumatic brain injury. 1 In contrast, chronic SDH is more commonly observed in elderly patients following minor or unperceived traumas. 1 Chronic SDH can be attributed to various factors, such as anticoagulants, antiplatelet drugs, chronic alcoholism, and intracranial hypotension. 2 Acute-on-chronic SDH may occur; however, the coexistence of ipsilateral EDH is rare. 3 Herein, we present the case of ipsilateral traumatic EDH and ipsilateral acute-on-chronic SDH in an elderly male. | CASE REPORTA 65-year-old male presented to the emergency with loss of consciousness following a road traffic accident. The patient was in the driving seat, not wearing a safety belt. The collision details and the exact timing of the injury could not be established. Personal history revealed arterial hypertension, for which the patient was taking amlodipine and valsartan, and ischemic heart disease, for which the patient was taking aspirin and clopidogrel. His personal history, family history, and psychosocial history were unremarkable.The Glasgow Coma Scale (GCS) score was 7 at the presentation, and a dilated left-sided pupil was observed. His vitals were a pulse rate of 58 per minute, blood pressure of 140/90 mm of Hg, and respiratory rate of 35 cycles per minute. A detailed neurological examination was not possible in the emergency setting.Immediate orotracheal intubation was done, two widebore intravenous lines were opened, and resuscitation was done with 0.9% normal saline. His blood investigations did not show any abnormalities. Coagulation profile tests were not done as the patient needed emergency surgery. Following this, we did an urgent computed tomography (CT) scan of the head, which revealed subdural hematoma,

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