Radiation exposure to surgeon and patient in intramedullary nailing of the lower limb.

Intramedullary nailing is probably the best method of treating long bone fractures in the lower limb. The operation is guided by fluoroscopy, for guide-wire insertion, fracture reduction and distal locking. No study so far has measured the scatter radiation to the patient's gonads during intramedullary, particularly femoral, nailing. The purpose here was to estimate the radiation hazard to the patients' gonads and surgeons' hands during intramedullary nailing for lower limb fractures. From April 1994 to June 1998, 184 consecutive patients had 224 nailings for lower limb fractures. Twenty-eight patients had Marchetti-Vincenzi nails and the rest had Russell-Taylor nails. There were 45 males and 40 females who had femoral nailing and 71 males and 28 females who had tibial nailing. The mean (range) age for femoral nailing was 56 (17-95.5) years and the mean age for tibia nailing was 44 (16.5-87.5) years. The average time of radiation when done by consultants was half that of middle-grade surgeons. The mean tibial nailing radiation time for the consultant was 0.56 min and for the middle-grade 1.28 min. The mean femoral nailing radiation time for the consultant was 0.52 min and for the middle-grade 1.61 min (P<0.05). The mean tibial and femoral nailing time were less for Marchetti nailing (P<0.05). Regular protection of the gonads of these patients is mandatory. This study shows that the radiation exposure for Marchetti-Vincenzi nailing is significantly less than for Russell-Taylor nailing. The overall radiation to patient gonads and surgeon hands was within acceptable limits.