Radiation exposure to the surgeon during closed interlocking intramedullary nailing

Area of Science:

• Orthopedic Surgery
• Medical Physics
• Radiological Protection

Background:

• Interlocking intramedullary nailing is a common surgical procedure for femoral and tibial fractures.
• Surgeons performing these procedures are potentially exposed to ionizing radiation from fluoroscopy.
• Quantifying radiation exposure is crucial for ensuring occupational safety in orthopedic surgery.

Purpose of the Study:

• To measure and evaluate the radiation doses received by the primary surgeon during interlocking intramedullary nailing.
• To compare measured doses against established governmental safety guidelines.
• To recommend precautions for minimizing radiation exposure during these procedures.

Main Methods:

• Twenty-five femoral and five tibial fractures were treated using interlocking intramedullary nailing.
• The primary surgeon wore a universal film badge (head/neck exposure) and a thermoluminescent dosimeter ring (dominant hand).
• Separate dosimetry was used for proximal and distal interlocking portions to differentiate radiation exposure.

Main Results:

• Average radiation dose to the head and neck was 7.0 mrem (deep) and 8.0 mrem (shallow) for the entire procedure.
• Average radiation dose to the dominant hand was 13.0 mrem during nail insertion/proximal interlocking and 12.0 mrem during distal interlocking.
• All recorded average doses were significantly below the government guidelines for a three-month period.

Conclusions:

• Interlocking intramedullary nailing procedures result in radiation exposure levels well within established safety limits for surgeons.
• The use of lead aprons and dosimeter rings effectively monitors and demonstrates the safety of the procedure.
• Adherence to recommended precautions can further minimize any potential risks associated with radiation exposure.