Radiation exposure to patients in lower limb trauma surgery

Fluoroscopy equipments have enabled us to perform operations that otherwise would be impossible but only at the expense of exposing the patients and theatre staff to radiation. The aim of this study was to determine the average radiation exposure to the patients in dynamic hip screw (DHS) fixation, cannulated hip screw (CHS) fixation, intra-medullary nailing (IMN) of femur and tibia operations. The records of all patients undergoing the above operations between May 2000 and August 2003 were retrospectively reviewed. A total of 670 patients were included. 389 had DHS, 85 had CHS, 125 had IMN of femur and 71 had IMN of tibia operations. The average radiation time was 0.7, 1.1, 2.5 and 2.1 min and the average radiation dose (in dose area product-DAP) was 196, 356, 548 and 125 cGy cm² for DHS, CHS, IMN of femur and IMN of tibia, respectively. Compared to the registrars, radiation time and dose were higher with the consultants in DHS fixation (P = 0.02, 0.02). The radiation dose was higher with the senior house officers compared to the registrars in CHS fixation (P = 0.03). There were no significant differences between the consultants and the registrars in IM nailing operations. The study concludes that radiation exposure to the patients in DHS and CHS operations depends on the experience of the surgeon but not in IMN operations. The IMN of femur involved more than four times higher radiation than IMN of tibia and the CHS fixation involved double the radiation than the DHS fixation. The radiation time was poor comparative metric to estimate radiation dose.