Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre

Radiation exposure from intra-operative fluoroscopy in orthopaedic trauma surgery is a common occupational hazard. References for fluoroscopy use in the operating room for commonly performed operations have not been reported adequately. This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure.

Data on 849 cases over an 18-month period were analysed retrospectively. Median and 75th centile values for dose area product (DAP), screening time (ST), and number of fluoroscopy images were calculated for procedures where n > 9 (n = 808).

Median DAP for dynamic hip screws for extracapsular femoral neck fractures was 668 mGy/cm² (ST 36 s), 1040 mGy/cm² (ST 49 s) for short proximal femoral nail, 1720 mGy/cm² (ST 2 m 36 s) for long femoral nail for diaphyseal fractures, 25 mGy/cm² (ST 25 s) for manipulation and Kirschner wire fixation in distal radius fractures, and 27 mGy/cm² (ST 23 s) for volar locking plate fixation in distal radius fractures. These represented the five commonest procedures performed in the trauma operating room in our hospital. Experienced surgeons utilized less radiation in the operating room than junior surgeons (DAP 90.55 vs. 366.5 mGy/cm², p = 0.001) and took fewer fluoroscopic images (49 vs. 66, p = 0.008) overall.

This study reports reference values for common trauma operations. These can be utilized by surgeons in the operating room to raise awareness and perform clinical audits of appropriate fluoroscopy use for orthopaedic trauma, using this study as guidance for standards. We demonstrated a significant reduction in fluoroscopy usage with increasing surgeon experience.