Radiation Exposure in Paediatric Orthopaedic Trauma Surgery

Area of Science:

• Medical Imaging
• Paediatric Orthopaedics
• Radiation Safety

Background:

• Fluoroscopy is essential in paediatric orthopaedic surgery, but national radiation exposure benchmarks are absent.
• Establishing local diagnostic reference levels (DRLs) is crucial for practice evaluation and patient safety.
• This study quantifies intraoperative radiation exposure in common paediatric orthopaedic procedures.

Purpose of the Study:

• To establish local reference ranges for intraoperative fluoroscopy radiation exposure.
• To benchmark current radiation exposure practices in paediatric orthopaedic surgery.
• To provide data supporting the development of national DRLs.

Main Methods:

• Retrospective observational study of 480 paediatric (<18 years) orthopaedic procedures over four years.
• Procedures categorized by anatomical region (elbow, ankle, pelvis) and type (MUA, MUA with K-wire, ORIF).
• Fluoroscopy radiation exposure (mGy/cm²) recorded and analyzed using descriptive statistics and Mann-Whitney U tests.

Main Results:

• Slipped upper femoral epiphysis (SUFE) pinning showed the highest mean exposure (384.5 mGy/cm²).
• Open reduction and internal fixation (ORIF) had highest elbow exposure (13.9 mGy/cm²); MUA with K-wire fixation had highest ankle exposure (12.4 mGy/cm²).
• MUA with K-wire procedures demonstrated significantly higher radiation exposure than simple MUA in elbow and ankle procedures (p < 0.001).

Conclusions:

• This study provides the first detailed local reference ranges for intraoperative fluoroscopy in paediatric orthopaedics.
• Significant procedure-specific variability in radiation exposure was observed.
• Findings support the development of local DRLs, promoting safer practices and national standardisation.