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Erschienen in: Archives of Orthopaedic and Trauma Surgery 4/2020

07.08.2019 | Orthopaedic Surgery

Radiation exposure in the treatment of pediatric supracondylar humerus fractures

verfasst von: Alex Schmucker, Roy Chen, Shobhan Vachhrajani, Melissa Martinek, Michael Albert

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 4/2020

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Abstract

Purpose

To determine the factors that influence radiation exposure during repair of supracondylar humerus fractures.

Methods

Medical records of almost 200 children with supracondylar fractures were retrospectively analyzed for variables correlated with fluoroscopy time and radiation dose as measures of radiation exposure.

Results

There was no statistically significant difference in fluoroscopy time (27 vs. 22 s p = 0.345) or direct radiation dose (0.394 vs. 0.318 mSv p = 0.290) between uniplanar and biplanar C-arm use. No statistically significant differences in fluoroscopy time or radiation dose were found for surgical technique, comorbid ipsilateral fractures, preoperative neurovascular compromise, or resident participation. There was a significant 8.3 s increase in fluoroscopy time (p = 0.022) and 0.249 mSv increase in radiation dose (p = 0.020) as the fracture type increased from II to III. An increase in one pin during CRPP resulted in a statistically significant 10.4 s increase in fluoroscopy time and a 0.205 mSv increase in radiation dose. There were significant differences between the physician with the lowest fluoroscopy time and radiation dose compared with the physicians with the two highest values for both fluoroscopy time and radiation dose (p < 0.01).

Conclusions

We found no significant difference in direct radiation exposure or fluoroscopy time when comparing biplanar to uniplanar C-arm use, resident participation, preoperative neurovascular compromise, or for comorbid ipsilateral fractures. Both outcomes increased significantly as fracture type increased from II to III and as the number of pins used during CRPP increased. Both outcomes were significantly different between the surgeons performing CRPP.
Literatur
1.
Zurück zum Zitat Niera JZSD, Prada-Cañizares A, Marti-Circuelos R, Pretell-Mazzini J (2015) Supracondylar humeral fractures in children:current concepts for the management and prognosis. Int Orthop 29(11):22872296 Niera JZSD, Prada-Cañizares A, Marti-Circuelos R, Pretell-Mazzini J (2015) Supracondylar humeral fractures in children:current concepts for the management and prognosis. Int Orthop 29(11):22872296
2.
Zurück zum Zitat Giachino AA, Cheng M (1980) Irradiation of the surgeon during pinning of femoral fractures. J Bone Jt Surg 62-B(2):227–229CrossRef Giachino AA, Cheng M (1980) Irradiation of the surgeon during pinning of femoral fractures. J Bone Jt Surg 62-B(2):227–229CrossRef
3.
Zurück zum Zitat Martus JE, Hilmes MA, Grice JV et al (2018) Radiation exposure during operative fixation of pediatric supracondylar humerus fractures. J Pediatr Orthop 38(5):249–253CrossRef Martus JE, Hilmes MA, Grice JV et al (2018) Radiation exposure during operative fixation of pediatric supracondylar humerus fractures. J Pediatr Orthop 38(5):249–253CrossRef
4.
Zurück zum Zitat National Research Council of the National Academies (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. The National Academies Press, Washington, DC National Research Council of the National Academies (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. The National Academies Press, Washington, DC
5.
Zurück zum Zitat ICRP (2007) The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 37(2–4):1–332 ICRP (2007) The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 37(2–4):1–332
6.
Zurück zum Zitat Badman BL, Rill L, Butkovich B, Arreola M, Griend RAV (2005) Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures. J Bone Jt Surg Am. 87(1):13–17CrossRef Badman BL, Rill L, Butkovich B, Arreola M, Griend RAV (2005) Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures. J Bone Jt Surg Am. 87(1):13–17CrossRef
7.
Zurück zum Zitat Bar-On R, Weigl DM, Becker T, Katz K, Konen O (2010) Intraoperative C-arm radiation affecting factors and reduction by an intervention program. J Pediatr Orthop 30(4):320–323CrossRef Bar-On R, Weigl DM, Becker T, Katz K, Konen O (2010) Intraoperative C-arm radiation affecting factors and reduction by an intervention program. J Pediatr Orthop 30(4):320–323CrossRef
8.
Zurück zum Zitat Eismann EA, Qall EJ, Thomas EC, Little MA (2014) Direct beam radiation exposure to surgeons during pinning of supracondylar humerus fractures. J Pediatr Orthop 34(2):166–171CrossRef Eismann EA, Qall EJ, Thomas EC, Little MA (2014) Direct beam radiation exposure to surgeons during pinning of supracondylar humerus fractures. J Pediatr Orthop 34(2):166–171CrossRef
9.
Zurück zum Zitat Esen E, Dogramaci Y, Gultekin S et al (2009) Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation. Acta Orthop Traumatol Turc 43:400–405CrossRef Esen E, Dogramaci Y, Gultekin S et al (2009) Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation. Acta Orthop Traumatol Turc 43:400–405CrossRef
10.
Zurück zum Zitat Hsu RY, Lareau CR et al (2014) The effect of C-arm position on radiation exposure during fixation of pediatric supracondylar fractures of the humerus. J Bone Jt Surg Am 96(15):e129CrossRef Hsu RY, Lareau CR et al (2014) The effect of C-arm position on radiation exposure during fixation of pediatric supracondylar fractures of the humerus. J Bone Jt Surg Am 96(15):e129CrossRef
11.
Zurück zum Zitat Kalenderer Ö, Turgut A, Bilgin E, Erkus S, İpci FB, Edizsoy TP (2018) The influence of resident level of training on fluoroscopy time in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Cureus 10(2):e2245PubMedPubMedCentral Kalenderer Ö, Turgut A, Bilgin E, Erkus S, İpci FB, Edizsoy TP (2018) The influence of resident level of training on fluoroscopy time in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Cureus 10(2):e2245PubMedPubMedCentral
12.
Zurück zum Zitat Na Y, Bai R, Zhao Z et al (2018) Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis. J Orthop Surg Res 13(1):68 (Published 2018 Apr 3) CrossRef Na Y, Bai R, Zhao Z et al (2018) Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis. J Orthop Surg Res 13(1):68 (Published 2018 Apr 3) CrossRef
13.
Zurück zum Zitat Riley SA (1989) Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clin Orthop Relat Res (248):257–260 Riley SA (1989) Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clin Orthop Relat Res (248):257–260
14.
Zurück zum Zitat Singer G, Herron B, Herron D (2011) Exposure from the large C-arm versus the mini C-arm using hand/wrist and elbow phantoms. J Hand Surg 36(4):628–631CrossRef Singer G, Herron B, Herron D (2011) Exposure from the large C-arm versus the mini C-arm using hand/wrist and elbow phantoms. J Hand Surg 36(4):628–631CrossRef
15.
Zurück zum Zitat Tremains MR, Georgiadis GM, Dennis MJ (2001) Radiation exposure with use of the inverted-c-arm technique in upper-extremity surgery. J Bone Jt Surg Am 83-A(5):674–678CrossRef Tremains MR, Georgiadis GM, Dennis MJ (2001) Radiation exposure with use of the inverted-c-arm technique in upper-extremity surgery. J Bone Jt Surg Am 83-A(5):674–678CrossRef
16.
Zurück zum Zitat Dekker AE, Krijnen P, Schipper IB (2016) Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: a systematic review and meta-analysis. Injury 47(11):2391–2398CrossRef Dekker AE, Krijnen P, Schipper IB (2016) Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: a systematic review and meta-analysis. Injury 47(11):2391–2398CrossRef
17.
Zurück zum Zitat Goldstone KE, Wright IH, Cohen B (1993) Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control. Br J Radiol 66(790):899–901CrossRef Goldstone KE, Wright IH, Cohen B (1993) Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control. Br J Radiol 66(790):899–901CrossRef
18.
Zurück zum Zitat Müller LP, Suffner J, Wenda K, Mohr W, Rommens PM (1998) Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury 29(6):461–468CrossRef Müller LP, Suffner J, Wenda K, Mohr W, Rommens PM (1998) Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury 29(6):461–468CrossRef
19.
Zurück zum Zitat Bushberg JT (2011) The essential physics of medical imaging. Wolters Kluwer, Philadelphia Bushberg JT (2011) The essential physics of medical imaging. Wolters Kluwer, Philadelphia
20.
Zurück zum Zitat Schueler BA, Vrieze TJ, Bjarnason H, Stanson AW (2006) An investigation of operator exposure in interventional radiology. Radiographics 26(5):1533–1541CrossRef Schueler BA, Vrieze TJ, Bjarnason H, Stanson AW (2006) An investigation of operator exposure in interventional radiology. Radiographics 26(5):1533–1541CrossRef
21.
Zurück zum Zitat Stahl CM, Meisinger QC, Andre MP, Kinney TB, Newton IG (2016) Radiation risk to the fluoroscopy operator and staff. Am J Roentgenol 207(4):737–744CrossRef Stahl CM, Meisinger QC, Andre MP, Kinney TB, Newton IG (2016) Radiation risk to the fluoroscopy operator and staff. Am J Roentgenol 207(4):737–744CrossRef
22.
Zurück zum Zitat Lee K, Lee KM, Park MS, Lee B, Kwon DG, Chung CY (2012) Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine 37(14):1240–1244CrossRef Lee K, Lee KM, Park MS, Lee B, Kwon DG, Chung CY (2012) Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine 37(14):1240–1244CrossRef
23.
Zurück zum Zitat Giordano BD, Grauer JN, Miller CP et al (2011) Radiation exposure issues in orthopaedics. J Bone Jt Surg Am 93(e69):1–10 Giordano BD, Grauer JN, Miller CP et al (2011) Radiation exposure issues in orthopaedics. J Bone Jt Surg Am 93(e69):1–10
24.
Zurück zum Zitat Khong P-L, Ringertz H, Donoghue V et al (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP. 42(2):1–63CrossRef Khong P-L, Ringertz H, Donoghue V et al (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP. 42(2):1–63CrossRef
25.
Zurück zum Zitat Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B (2005) Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med 55(6):498–500CrossRef Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B (2005) Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med 55(6):498–500CrossRef
26.
Zurück zum Zitat Singer G (2005) Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg 13(1):69–76CrossRef Singer G (2005) Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg 13(1):69–76CrossRef
27.
Zurück zum Zitat Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20):2637–2645CrossRef Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20):2637–2645CrossRef
28.
Zurück zum Zitat Hayda RA, Hsu RY, DePasse JM, Gil JA (2018) Radiation exposure and health risks for orthopaedic surgeons. J Am Acad Orthop Surg 26(8):268–277CrossRef Hayda RA, Hsu RY, DePasse JM, Gil JA (2018) Radiation exposure and health risks for orthopaedic surgeons. J Am Acad Orthop Surg 26(8):268–277CrossRef
29.
Zurück zum Zitat Sung KH, Min E, Chung CY, Jo BC, Park MS, Lee K (2016) Measurements of surgeons’ exposure to ionizing radiation dose: comparison of conventional and mini C-arm fluoroscopy. J Hand Surg Eur Vol 41(3):340–345CrossRef Sung KH, Min E, Chung CY, Jo BC, Park MS, Lee K (2016) Measurements of surgeons’ exposure to ionizing radiation dose: comparison of conventional and mini C-arm fluoroscopy. J Hand Surg Eur Vol 41(3):340–345CrossRef
Metadaten
Titel
Radiation exposure in the treatment of pediatric supracondylar humerus fractures
verfasst von
Alex Schmucker
Roy Chen
Shobhan Vachhrajani
Melissa Martinek
Michael Albert
Publikationsdatum
07.08.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 4/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-019-03251-2

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