title: Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study.
abstract: BACKGROUND
  The objective of this clinical trial was to determine whether there is a skill dependence for the total amount of radiation exposure to orthopaedic surgeons caused by fluoroscopy during intramedullary fracture fixation.
  
  
  METHODS
  Surgical teams were assigned to either the 'Senior group' or the 'Junior group' according to their professional qualification and clinical appointment. Twenty-two long-bone shaft fractures were stabilized with intramedullary nails. The radiation exposure was measured at different body locations including fingers, trunk and head by means of thermoluminescent LiF:Mg,Cu,P detectors. The total time of fluoroscopy was registered for each operation.
  
  
  RESULTS
  Mean time of fluoroscopy per operation was 4.43 min for the 'Senior group' and 6.95 min for the 'Junior group'. The surgeons' hands were exposed to markedly higher doses (range 0-2.88 mSv 'Senior group'; 0-11.94 mSv 'Junior group') than their trunk and head (range 0-0.27 mSv 'Senior group'; 0-0.38 mSv 'Junior group'). After analysis of variance, differences between both groups proved to be statistically significant for all fingers measured (p</=0.02) and for the total time of fluoroscopy (p=0.019).
  
  
  CONCLUSIONS
  Generally, the hands are at higher risk than are the trunk and the head, and this finding is independent of surgical skills. However, an additional hazard is created for the less experienced surgeon by a highly varying and poorly predictable exposure of the hands and time needed for fluoroscopy. Thus, the use of radiation is more consistent and standardized with a skilled surgeon.
authors.affiliation: Trauma Surgery, Wuerzburg University Hospital, Oberduerrbacher Strasse 6, 97080 Wuerzburg, Germany. blattert@chirurgie.uni-wuerzburg.de
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Blattert
authors.forename: Ute A
authors.initials: UA
authors.lastname: Fill
authors.forename: Elmar
authors.initials: E
authors.lastname: Kunz
authors.forename: Werner
authors.initials: W
authors.lastname: Panzer
authors.forename: Arnulf
authors.initials: A
authors.lastname: Weckbach
authors.forename: Dieter F
authors.initials: DF
authors.lastname: Regulla
mesh_terms: D002983:Clinical Competence; D005471:Fluoroscopy; D005594:Fracture Fixation, Intramedullary; D006225:Hand / Q000528:radiation effects; D006801:Humans; D016273:Occupational Exposure; D009985:Orthopedics; D011829:Radiation Dosage; D011874:Radiometry; D013819:Thermoluminescent Dosimetry