Related Experiment Video
Updated: Mar 19, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Radiation Exposure During Operative Fixation of Pediatric Supracondylar Humerus Fractures: Is Lead Shielding
Jeffrey E Martus1, Melissa A Hilmes2, Jared V Grice3
1Division of Pediatric Orthopaedics.
Insights
Intraoperative fluoroscopy for pediatric supracondylar humerus fractures resulted in minimal radiation exposure to the thyroid and gonads. Lead shielding is still recommended for radiosensitive organs to minimize cumulative lifetime radiation exposure.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Operative fixation of pediatric supracondylar humerus (SCH) fractures involves radiation exposure.
- Previous studies have not quantified radiation dose to radiosensitive organs in pediatric patients undergoing SCH fracture repair.
- Intraoperative fluoroscopy may pose a significant radiation risk to pediatric patients.
Purpose of the Study:
- To quantify radiation exposure at the thyroid and gonads during operative fixation of pediatric SCH fractures.
- To evaluate the effectiveness of lead shielding for radiosensitive organs.
- To test the hypothesis that intraoperative fluoroscopy significantly exposes pediatric patients to radiation.
Main Methods:
- A prospective quality improvement study measured radiation doses using dosimeters placed on thyroid and gonadal lead shields during percutaneous fixation of SCH fractures.
- Fluoroscopy times and radiation doses were recorded and analyzed.
- Prospective data was compared to a retrospective cohort to ensure representativeness.
Main Results:
- Prospective cohort (18 patients): Mean fluoroscopy time was 65.0 seconds; mean absorbed skin dose at the elbow was 0.47 mGy.
- Equivalent doses to the thyroid and gonads were minimal (<0.01 mSv) in all prospective patients.
- No statistically significant differences in fluoroscopy time or radiation dose were found between the prospective and retrospective cohorts (163 patients).
Conclusions:
- Radiation exposure to the thyroid and gonads during pediatric SCH fracture fixation is minimal, comparable to daily background radiation.
- Dosimeter measurements from the prospective cohort are representative of typical intraoperative radiation exposure.
- While doses are minimal, lead shielding remains appropriate to minimize cumulative lifetime radiation exposure, especially in smaller children or during prolonged procedures.
Background:
Factors that impact radiation exposure during operative fixation of pediatric supracondylar humerus (SCH) fractures have been investigated; however, no studies have measured the equivalent dose at the patient's radiosensitive organs. Our hypothesis was that intraoperative fluoroscopy exposes pediatric patients to a significant radiation load and lead shielding of radiosensitive organs is important. The goal of the study was to quantify the patient's radiation exposure during the procedure by measuring the radiation load at the thyroid and gonads.
Methods:
A prospective quality improvement project of radiation exposure during percutaneous fixation of isolated SCH fractures was performed over a 4-week period. The c-arm image intensifier was used as the operating table and radiation dosimeters were positioned over the thyroid and gonadal lead shields. Fluoroscopy times were recorded, doses were calculated, and the dosimeters were analyzed. To assure that the prospective cohort was representative of a larger population of SCH fractures, demographics and fluoroscopy time of the prospective cohort were compared with a 12-month retrospective cohort in which dosimetry was not performed.
Results:
Prospective cohort-18 patients with type 2 (8) and type 3 (10) fractures were prospectively studied with intraoperative measurement of thyroid and gonadal radiation equivalent doses. Mean age was 4.9 years (1.9 to 9.5 y) and mean weight was 21.4 kg (13.1 to 33.5 kg). Mean fluoroscopy time was 65.0 seconds (25.3 to 168.4 s), and absorbed skin dose at the elbow was 0.47 mGy (0.18 to 1.21 mGy). The radiation dosimeters overlying the thyroid and gonads measured minimal radiation indicating equivalent doses of <0.01 mSv for all patients in the prospective cohort.Retrospective cohort-163 patients with type 2 (60) and type 3 (103) fractures were retrospectively studied. The mean age was 5.5 years (0.02 to 13.7 y) and weight was 21.6 kg (2.0 to 71.9 kg). Mean fluoroscopy time was 74.1 seconds (10.2 to 288.9 s), and absorbed skin dose at the elbow was 0.53 mGy (0.07 to 2.07 mGy).There were no statistically significant differences between the cohorts.
Conclusions:
The smaller prospective cohort had fluoroscopy times and radiation doses that were not statistically different from the larger retrospective cohort, suggesting that the dosimeter measurements are representative of intraoperative radiation exposure during fixation of pediatric SCH fractures. The equivalent dose to the thyroid and gonads was minimal and approximates daily background radiation. Shielding of radiosensitive organs is appropriate when practical to minimize cumulative lifetime radiation exposure, particularly in smaller patients and when longer fluoroscopy times are anticipated.
Level Of Evidence:
Level 2.
