Differences in Intraoperative Fluoroscopic Radiation Exposure During Ankle Fracture Open Reduction and Internal...

Area of Science:

• Orthopaedic Surgery
• Podiatric Surgery
• Medical Imaging

Background:

• Ankle fractures requiring surgical intervention are managed by both orthopaedic surgeons and podiatrists.
• Intraoperative fluoroscopy is standard for these procedures, but carries risks of radiation exposure.
• Minimizing radiation dose is crucial for patient and surgical team safety.

Purpose of the Study:

• To compare intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) between orthopaedic surgeons and podiatrists.
• To determine if differences exist in fluoroscopic time and radiation dose based on surgical specialty.
• To identify potential safety improvements in managing surgical ankle fractures.

Main Methods:

• Retrospective review of 333 ankle fracture ORIF cases at a Level I trauma center (2018-2023).
• Patients stratified by surgical specialty (orthopaedic surgery vs. podiatry).
• Comparison of mean total radiation dose (mRad) and fluoroscopic time (seconds) using multiple linear regression analysis.

Main Results:

• Orthopaedic surgery cases showed significantly lower mean fluoroscopic time for isolated malleolus ORIF with syndesmosis repair (68.4s vs. 104.8s, P=0.028).
• Trimalleolar ORIF with syndesmotic repair by orthopaedic surgeons resulted in a significantly lower mean radiation dose (244.6 mRad vs. 565.6 mRad, P=0.009).
• These differences were statistically significant after controlling for patient demographics and BMI.

Conclusions:

• Orthopaedic surgeons achieve lower radiation exposure and fluoroscopic times in specific ankle fracture ORIF procedures.
• Performing isolated malleolar and trimalleolar ORIF with syndesmosis repair by orthopaedic surgeons may enhance safety.
• Further investigation into practice variations and their impact on radiation safety is warranted.