Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre

Rashid, Mustafa S.; Aziz, Sheweidin; Haydar, Syed; Fleming, Simon; Datta, Amit

doi:10.1007/s00590-017-2020-y

Cited by 50 publications

(53 citation statements)

References 14 publications

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“…By avoiding the use of fluoroscopy, the surgeon may decrease surgery duration, especially during the learning phase of the use of intraoperative fluoroscopy. 11,12 It will also eliminate potential risks associated with intraoperative irradiation of the surgical staff. Finally, it will reduce the cost of the equipment, and therefore the surgery, necessary for fixing the fracture.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats

Cabassu¹

2019

Vet Comp Orthop Traumatol

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Objective The aim of this study was to prospectively evaluate postoperative alignment when using fracture reduction under the plate (FRUP) during a minimally invasive plate osteosynthesis in tibial and femoral fractures, without intraoperative imaging, and report immediate postoperative complications. Materials and Methods After precise plate contouring and preoperative planning, FRUP was obtained with one cortical screw per fragment. Fractures were stabilized with a plate or plate rod. Tibial/femoral lengths, tibial plateau angles, mechanical medial proximal and distal tibial angles, anatomical lateral distal femoral angles, femoral curvatum and neck anteversion were evaluated on postoperative radiographs and contralateral bone. Tibial torsion was evaluated visually. Paired t-test were used to compare data. Immediate postoperative complications were recorded. Results Twenty-one tibial and 20 femoral fractures were stabilized (14 plate rod cases). Mean postoperative operated tibial length was 1.4% shorter (p = 0.001). Mean postoperative operated femoral length was 2% shorter (p = 0.04). Mean operated tibial plateau angle was 1.1° lower (p = 0.02). No difference in tibial torsion was noticed. No significant difference in mechanical medial proximal tibial angle, mechanical medial distal tibial angle, anatomical lateral distal femoral angle and femoral neck anteversion was observed. Mean operated femoral curvatum angle was 5.6° less (p = 0.01). Five cases (3 plate rod cases) required an immediate revision. Clinical Significance Minimally invasive plate osteosynthesis with FRUP leads to acceptable postoperative alignment. Correct pin placement should be evaluated.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats

Cabassu¹

2019

Vet Comp Orthop Traumatol

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“…also divided experience levels based on tiers of consultants, Staff Grade/Associate Specialists and Specialist training registrars. 32 Botchu et al . instead of using grade/tier, used the number of years practicing to define experience level.…”

Section: Grading Of Surgeon Experiencementioning

confidence: 99%

“…19,20,22 Two studies additionally reported the number of films/exposures taken. 25,32 One study used the number of films with part of surgeon’s body as a measure of radiation exposure. 25 This was expressed in terms of percentage of the total number of films.…”

Section: Outcomes Studiedmentioning

confidence: 99%

Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Malik¹,

Hussain²,

Lakdawala³

et al. 2019

Orthop Rev (Pavia)

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With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience levels and their effect on the primary outcomes. A total of eighteen studies were included in the review. The studies were a mix of prospective and retrospective studies with low to moderate quality as evaluated by the MINORs criteria. Studies were variable in defining surgeon experience levels and in the type of operations being performed. Majority of the studies showed that inexperienced surgeons/trainees had a higher total fluoroscopy time and a higher mean radiation exposure as compared to experienced surgeons. We conclude that higher surgeon experience significantly reduces usage of fluoroscopy and the consequent radiation exposure in orthopedic procedures. Introduction of strict radiation guidelines involving limited usage of fluoroscopy and supervision of trainees may be beneficial in controlling radiation exposure in the future.

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“…Other complications have been reported with distally locked constructs, including implant failure (0.2%), screw loosening and breaking, drill bit breaking (0.4%), soft tissue irritation, intramuscular haematoma and compartment syndrome. 10 , 40 , 44 , 45 , 46 Higher radiation exposure for the surgical team is also a factor to consider in distally locked nails. 45 …”

Section: Resultsmentioning

confidence: 99%

“… 10 , 40 , 44 , 45 , 46 Higher radiation exposure for the surgical team is also a factor to consider in distally locked nails. 45 …”

Section: Resultsmentioning

confidence: 99%

Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm

et al. 2020

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Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability. Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045

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Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre

Cited by 50 publications

References 14 publications

Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats

Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats

Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm

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