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Updated: Sep 17, 2025
In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
Published on: July 2, 2021
Fluoroscopy in Hip Fracture Surgery: An Analysis of Resident Utilization
Evan Williams1,2, Geb W Thomas1,2, Donald D Anderson1,2,3
1Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Background:
Fluoroscopy is a critical tool in operative fracture reduction and fixation that residents begin using early in their careers. Judiciously managing fluoroscopy use in a procedure should be a focus in training. Total radiation dose is routinely recorded, but the distribution of fluoroscopy use throughout a procedure has not been well researched. This study aimed to determine how much fluoroscopy residents use in cephalomedullary nail (CMN) fixation of hip fractures. The study further sought to identify distinct tasks in the procedure that require more or less fluoroscopy.
Methods:
Eighty-five CMN cases for which complete sets of fluoroscopic images were available were studied. Nine distinct tasks were analyzed in each case: set up, reduction, entry point navigation, reaming, nail placement, femoral head navigation, proximal screw placement, distal screw(s) placement, and final checks. Image use and time elapsed during tasks was recorded and attributed to the most-junior resident, who would typically be most hands-on at our institution for this procedure.
Results:
Residents completed CMN placement in an average of 66.2 minutes (± 31.7) using an average of 185 images (± 113). Entry point navigation required the most time, 14 ± 10.8 minutes, and images, 49 ± 42. This was a significantly greater use of time (t(121) = 4.96, p < 0.001) and images (t(133) = 3.45, p < 0.001) than other tasks.
Conclusion:
These data highlight the sheer volume of fluoroscopy used by residents in a common procedure. The sub-task analysis indicates that the freehand entry point navigation requires the greatest use of fluoroscopy and time, suggesting residents may benefit from additional laboratory-based training on this portion of the procedure.
Clinical Relevance:
Orthopedic surgeons utilize fluoroscopy in a wide array of procedures. These findings emphasize the need to be intentional in the use of intra-operative fluoroscopy over a decades long career to prevent its potentially harmful effects. These results can also be used to improve education by creating objective metrics to evaluate resident fluoroscopy use and provide feedback.
