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Can a Teaching Programme Help Reduce Radiation Exposure During Extra-Capsular Proximal Femur Fracture Fixation?
Owen Mitchell1, Joel Xavier1, Qamar Mustafa2
1Trauma and Orthopaedics, Dorset County Hospital NHS Foundation Trust, Dorchester, GBR.
Cureus
|December 15, 2025
Summary
A departmental teaching program showed non-significant reductions in radiation exposure for proximal femur fracture fixation using Dynamic Hip Screws and short intramedullary nails. However, long intramedullary nail procedures saw a significant increase in radiation dose, highlighting the need for comprehensive training and audit.
Area of Science:
- Orthopaedic Surgery
- Radiological Safety
- Medical Physics
Background:
- Proximal femur fractures (PFFs) are a significant healthcare burden in the UK, with ~76,000 annual cases.
- Extra-capsular PFFs often require intraoperative fluoroscopy (e.g., Dynamic Hip Screws (DHS), intramedullary nails (IMNs)), exposing patients and staff to ionising radiation.
- Current radiation safety knowledge varies, with no established benchmarks, despite Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R).
Purpose of the Study:
- To assess if a departmental teaching program could reduce radiation exposure during extra-capsular PFF fixation.
- To explore differences in radiation exposure between consultant- and trainee-led cases.
- To evaluate the impact of an educational intervention on radiological stewardship.
Main Methods:
- An audit at Dorset County Hospital (audit number 6323) included patients with closed extra-capsular PFFs treated with DHS, short, or long IMNs.
- Radiation exposure (dose-area product, DAP) was recorded pre- and post-intervention using PACS.
- Statistical analysis involved independent t-tests (P < 0.05) and Cohen's d for effect sizes.
Main Results:
- Overall mean radiation exposure decreased marginally (347.4 to 344.6 cGycm²; P=0.97).
- Reductions were noted for DHS (245.6 to 210.8 cGycm²; P=0.40) and short IMNs (605.9 to 375.9 cGycm²; P=0.18).
- Long IMN fixation showed a significant increase in mean dose (246.8 to 764.5 cGy·cm²; P=0.01). Consultant-led cases showed a non-significant increase, while other grades had a small, non-significant reduction.
Conclusions:
- A single teaching session yielded non-significant radiation exposure reductions for DHS and short IMN procedures, supporting targeted education's role.
- The increase in long IMN exposure likely reflects procedural complexity, not educational failure.
- Sustained improvements require integrated simulation, feedback, optimised protocols, and regular audits to adhere to IR(ME)R principles.
