Estimation of Patient Dose and Associated Radiogenic Risks from Limb Lengthening

Schiedel, F.; Buller, Tim C.; Rödl, Robert

doi:10.1007/s11999-008-0624-6

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…It is obvious from Table 2 that the average number of X-ray views required is 15. The number of X-rays for following similar cases treated with bone transport by other workers is 30 X-ray views per patient 24. This indicates that nearly 2 times less X-rays are required for the fractures monitored by electrical conduction.…”

Section: Discussionmentioning

confidence: 94%

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Monitoring of fracture healing by electrical conduction: A new diagnostic procedure

Kumaravel¹,

Sundaram

2012

IJOO

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Background:Electrical stimulation of fractures has been reported to enhance fracture healing. X-rays are normally used to assess union of fractures. Electrical conduction is not tried as a tool to study fracture healing. The current study focuses on electrical conduction as a diagnostic tool to assess fracture healing and new bone formation. The aim was to find if electrical resistance across the fracture can be used as a tool to study fracture healing which can be verified with simultaneous radiographs.Materials and Methods:A prospective study was conducted where 12 open fractures of tibia, including two with bone defects were evaluated. They were debrided and four-carbon ring Ilizarov external fixators were applied. Their healing was followed with clinical assessment and periodical X-rays till the endpoint of fracture union and then the rings were removed. In addition, all these cases also had application of electrical voltage in the range of 0.1–1.0 V DC in 0.1 V increments, across the two wires on either side of fracture. The output current was recorded by an ammeter connected in series. Resistance calculated for various voltages was plotted as a graph for the period of fracture treatment and the characteristics were studied. This graph was compared with the appearance of new bone in the X-rays.Results:In all cases, when the above graph stabilized, in the consecutive recordings, the X-rays showed healing (bridging callus) matching the curve and the patient was able to load the limb. The time of stabilization of this graph for a specific voltage was different in individual cases. However, for a given case, the resistance characteristics were the same for the entire voltage range of 0.1–1.0 V.Conclusion:If the resistance versus day curve stabilizes on the consecutive recordings, we can predict that the fracture is in the process of healing. This stabilization period also matched the patients’ ability to comfortably load the limb and also the radiographs which showed bridging callus (healing). If this is used as a positive criterion for fracture healing in future, the radiation exposure by X-rays shall be less.

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Section: Discussionmentioning

confidence: 94%

“…The number of X-rays for following similar cases treated with bone transport by other workers is 30 X-ray views per patient. 24 This indicates that nearly 2 times less X-rays are required for the fractures monitored by electrical conduction. The minimum effective dose to produce each view of leg X-ray is 1.54 μSv.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of fracture healing by electrical conduction: A new diagnostic procedure

Kumaravel¹,

Sundaram

2012

IJOO

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“…Schiedel et al ., 18 showed that femur lengthening may result in a higher cumulative organ dose which meant higher radiogenic risks to patients compared with tibial lengthening. Moreover, tibial lengthening has no interference on the structure of the hip joints and can preserve the ROM of hip without any obstacle to a future THA procedure.…”

Section: Discussionmentioning

confidence: 99%

Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

Wan

Zhang

Lin

et al. 2014

IJOO

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Background:Developmental dysplasia of the hip (DDH) is associated with chronic pain and limping which especially has a negative impact on the patients’ daily activities, body image, and self-esteem. Although total hip arthroplasty remains the first choice for treatment of DDH in adults, minimally invasive alternative approaches are being increasingly favored both by the surgeon and the patients with severe DDH. This study aimed to evaluate the outcome of these patients treated with a mono-lateral external fixator-based tibial lengthening procedure.Materials and Methods:During the period of month between June 1999 and January 2006, 13 (mean ages 20.8 years) adult patients with unilateral Crowe type-IV DDH were treated by tibial lengthening using a mono-lateral external fixator over an intramedullary nail. Bone healing, infection, gait correction and improvement in body image were assessed during postoperative followup. Patients’ overall health status at the end of followup was assessed using the short form-36 (SF-36) health survey.Results:Patients were followed up for an average of 7.3 years. Successful bone healing was observed in all 13 patients and no further surgeries were indicated. A mean external fixation index of 12.4 days/cm was achieved. Bone formation fell in good to excellent categories with a mean consolidation index of 50.1 days/cm. Pin-tract infections were observed in two patients. The degree of limping was reduced from severe or moderate preoperatively to mild postoperatively. Neither equinus deformity nor painful degenerative osteoarthritis and hip dysfunction were observed in any of the patients studied. The SF-36 questionnaire survey showed that all patients were satisfied with their outcomes.Conclusions:Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications.

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“…Such frequent exposure to X-rays can cause marrow depression and malignancy [ 1 – 3 ]. Sometimes even around 30 X-rays are needed in a single patient till union [ 4 ]. X-ray analysis is not always consistent, as maturity in viewing a fracture radiograph depends on individual medical practitioner's skill and experience which leads to interobserver and intraobserver variations.…”

Section: Introductionmentioning

confidence: 99%

Tibia Fracture Healing Prediction Using First-Order Mathematical Model

Sridevi¹,

Periasamy²,

Kumaravel

et al. 2015

Computational and Mathematical Methods in Medicine

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The prediction of healing period of a tibia fracture in humans across limb using first-order mathematical model is demonstrated. At present, fracture healing is diagnosed using X-rays. Recent studies have demonstrated electric stimulation as a diagnostic tool in fracture healing. A DC electric voltage of 0.7 V was applied across the fracture and stabilized with Teflon coated carbon rings and the data was recorded at different time intervals until the fracture heals. The experimental data fitted a first-order plus dead time zero model (FOPDTZ) that coincided with the mathematical model of electrical simulated tibia fracture limb. Fracture healing diagnosis was proposed using model parameter process gain. Current stabilization in terms of process gain parameter becoming constant indicates that the healing of fracture is a new finding in the work. An error analysis was performed and it was observed that the measured data correlated to the FOPDTZ model with an error of less than 2 percent. Prediction of fracture healing period was done by one of the identified model parameters, namely, process gain. Moreover, mathematically, it is justified that once the fracture is completely united there is no capacitance present across the fracture site, which is a novelty of the work.

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Estimation of Patient Dose and Associated Radiogenic Risks from Limb Lengthening

Cited by 8 publications

References 15 publications

Monitoring of fracture healing by electrical conduction: A new diagnostic procedure

Monitoring of fracture healing by electrical conduction: A new diagnostic procedure

Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

Tibia Fracture Healing Prediction Using First-Order Mathematical Model

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