Fluoroscopy Use and Radiation Exposure in Distal Radius Fracture Fixation

The primary aim of this study was to quantify radiation exposure during the surgical fixation of distal radius fractures (DRF). Secondary aims included determining patient and surgeon factors associated with higher intraoperative fluoroscopic use.

This retrospective study included 342 patients with DRF who underwent acute surgical fixation between January 1, 2017, and June 1, 2019. Inclusion criteria were patient age older than 18 years with acute DRF undergoing surgical fixation. Exclusion criteria were patient age younger than 18 years, additional fractures undergoing simultaneous fixation, and bilateral DRF requiring fixation. Patient demographics, surgeon factors, and fluoroscopy data were collected through chart reviews. Univariate and bivariate analyses were performed, and P<0.05 was considered significant.

The median patient age was 59 years, and 77.8% were women. The median dose area product (DAP) was 9.24 cGy*cm² per case. The median number of images obtained per case was 36, and the median fluoroscopy time was 60 seconds, equating to a dose of 0.39 mGy/min. Higher radiation exposure was associated with male patients, more complex fracture morphology, type of implant chosen, junior attendings as primary surgeon, surgeon subspecialty, and surgical assistant training level.

Intraoperative fluoroscopic use during DRF surgical fixation is associated with both patient injury characteristics as well as surgeon factors. Male patients and fracture morphology, as well as surgeon experience and the presence of trainees, all increase fluoroscopic use and radiation exposure.