Khan Muhammad Junaid, Juanroyee Ahmed, Janan Hassan, Waheed Khawar, Mohammed Riaz
Trauma and Orthopaedics, Gloucestershire Royal Hospital, Gloucester, GBR.
Cureus. 2025 Jun 16;17(6):e86108. doi: 10.7759/cureus.86108. eCollection 2025 Jun.
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.
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.
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.
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.
股骨近端骨折是英国最常见的骨科损伤之一。术中透视对于精确的骨折固定至关重要，但会使患者和手术团队暴露于电离辐射中，增加了患白内障和某些癌症等并发症的风险。尽管各种指南旨在降低这些风险，但持续实施仍然是一项挑战，而且描述外科医生主导的直接减少术中暴露技术的文献有限。
在英国一家单一的地区综合医院进行了一项病例对照研究，该医院每年进行超过900例髋部骨折手术。该研究纳入了125名成年患者（年龄超过18岁），他们被诊断为AO A1型和A2型粗隆间骨折，在2020年7月至2025年1月期间接受了长柄股骨近端髓内钉（Intertan）或动力髋螺钉（DHS）手术治疗。从图片存档与通信系统（PACS）中存档的剂量报告中收集了两位经验丰富的创伤外科医生所进行手术的剂量面积乘积（DAP）和透视时间数据。病例分为两组：一组手术未使用标记技术，另一组使用了该技术。本研究旨在通过比较两组来评估标记方法对辐射暴露的影响。可观察到的减少将突出其在提高辐射安全性和临床实践中的价值。
在使用标记技术的Intertan组中，DAP和透视时间均显著减少。平均DAP从194.47 UGy×m²降至105.65 UGy×m²，降幅为45%（p = 0.0001），平均透视时间从126.30秒降至92.12秒（p = 0.001），降幅为27%。在Intertan和DHS手术的对照组中，DAP和透视暴露时间的平均值均有所降低；然而，观察到的减少仅在Intertan组中具有统计学意义。
标记技术在不影响手术效率的情况下，有效地减少了Intertan固定过程中的辐射暴露。它简单、可重复且易于传授，在培训环境和轮转手术室团队中特别有用。通过简化透视定位，该技术促进了与放射技师更好的沟通，并支持遵守推荐的辐射安全原则。尽管本研究受单中心设计和小样本量的限制，但为提高髋部骨折手术辐射安全性的实用方法提供了早期证据。建议进行更大样本量的进一步研究，以探索更广泛的适用性及其对手术效率的影响。
