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Radiation Exposure During Surgery for Leg Fractures
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Posted on: 11/30/1999
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Spiral fractures of the leg in children usually require surgery. A closed procedure may be possible if the break is short enough. Unstable, long fractures with multiple fragments will require an open operation.
Closed fracture repair can be done as a minimally invasive (MI) procedure. With MI surgery, only a small incision is required. The surgeon often relies on an imaging technique called fluoroscopy. This is a type of X-ray that allows the surgeon to see the bones while inserting and passing pins into the leg and through the bone.
In young children, there is some concern about the length of time they are exposed to radiation from this imaging tool. The surgeon and surgical staff are also exposed. Efforts are being made to reduce the total radiation dosage everyone is exposed to.
In this study, the length of time and dosage are measured for children with lower-extremity shaft fractures. The shaft refers to the main part of the long bone, rather than the top or bottom of the bone.
The average time children with femoral (thigh bone) shaft fractures were exposed to intensified radiation was about 70 seconds. This time was longer when the surgery was complex or when surgeons were being trained. Average radiation time was less for fractures of the lower leg.
The authors make several suggestions to help reduce radiation exposure in children with long fractures of the leg bones. First, pediatric trauma units should keep exposure to fluoroscopy to less than two minutes for lower leg bone fractures of the shaft.
A similar guideline should be applied to femoral shaft fractures but the time can be extended to three minutes. Routine use of the radiation imaging longer than this suggests a need to review the equipment. It's possible the fluoroscopy device is outdated and should be replaced.
If the surgeon suspects radiation exposure will be longer, then an open incision should be considered instead of a closed reduction.
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References:
Ralf Kraus, MD, et al. Elastic Stable Intramedulllary Nailing in Pediatric Femur and Lower Leg Shaft Fractures. In Journal of Pediatric Orthopaedics. January/February 2008. Vol. 28. No. 1. Pp. 14-16.
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