The Effect of a Simple and Reproducible Marking Technique on Enhancing Radiation Safety in Surgical Fixation of Proximal Femur Fractures.

INTRODUCTION

Proximal femur fractures are among the most common orthopaedic injuries in the UK. Intraoperative fluoroscopy is essential for precise fracture fixation but exposes both patients and surgical teams to ionising radiation, increasing the risk of complications such as cataracts and certain cancers. While various guidelines aim to mitigate these risks, consistent implementation remains a challenge, and there is limited literature describing surgeon-led techniques to directly reduce intraoperative exposure.

METHODS

A case-control study was carried out at a single district general hospital in the UK, which performs over 900 hip fracture surgeries annually. The study involved 125 adult patients (aged over 18) diagnosed with AO type A1 and A2 intertrochanteric fractures, who underwent surgical treatment with either a long cephalomedullary femoral nail (Intertan) or a dynamic hip screw (DHS) between July 2020 and January 2025. Data on dose area product (DAP) and screening time were collected from dose reports archived in the Picture Archiving and Communication System (PACS) for procedures performed by two experienced trauma surgeons. The cases were categorised into two groups: one in which the operations were conducted without using the marking technique, and the other where it was applied. The study aims to evaluate the marking method's impact on radiation exposure by comparing two groups. An observable reduction would underscore its value in enhancing radiation safety and clinical practice.

RESULTS

A significant reduction in both DAP and screening time was observed in the Intertan group using the marking technique. Mean DAP decreased by 45% from 194.47 to 105.65 UGy × m² (p = 0.0001), and mean screening time reduced from 126.30 to 92.12 seconds (p = 0.001), a reduction by 27%. The mean values for DAP and fluoroscopic exposure time were reduced in the control group for both Intertan and DHS procedures; however, the observed reduction was statistically significant only in the Intertan group.

DISCUSSION

The marking technique was effective in reducing radiation exposure during Intertan fixation without compromising surgical efficiency. It is simple, reproducible, and easy to teach, making it particularly useful in training settings and among rotating theatre teams. By streamlining fluoroscopy positioning, the technique promotes better communication with radiographers and supports adherence to the recommended principles of radiation safety. While limited by its single-centre design and small sample size, this study provides early evidence for a practical method of enhancing radiation safety in hip fracture surgery. Further research with larger cohorts is recommended to explore broader applicability and impact on operative efficiency.