Differences in Intraoperative Fluoroscopic Radiation Exposure During Ankle Fracture Open Reduction and Internal Fixation Between Orthopaedic Surgery and Podiatry.

Monica DiFiori, Kristofer Bires, Gavin Rallis, Eric Gokcen
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Abstract

Surgical ankle fractures pose a unique situation because both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used; however, excessive radiation can be harmful to both the patient and the surgical team. The primary goal of this study was to determine whether there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018, and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients aged older than 18 years with an ankle fracture managed surgically were included. Subjects were then stratified by procedure. The mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Of the 333 included procedures, 186 were done by orthopaedic surgeons and 147 were done by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared with those performed by podiatry (68.4 s versus 104.8 s; P = 0.028). In addition, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared with those performed by podiatry (244.6 mRad v 565.6 mRad; P = 0.009). Patients and surgical teams are exposed to markedly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared with those performed by a podiatrist.

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矫形外科和足病科在踝关节骨折切开复位和内固定术中术中透视辐射暴露的差异。
踝关节骨折手术的情况比较特殊,因为足病医生和矫形外科医生都会处理这些损伤。术中透视是常规的做法,但过量的辐射会对患者和手术团队造成伤害。本研究的主要目的是确定在踝关节骨折切开复位内固定术(ORIF)中,骨科医生与足病医生的术中辐射量是否存在差异。这是一项回顾性研究,研究对象是2018年1月1日至2023年4月1日期间在城市一级创伤中心接受踝关节骨折开放复位内固定术的患者。我们使用与踝关节骨折相关的《国际疾病分类》第 9 条和第 10 条代码查询了电子健康记录。纳入了年龄大于 18 岁、踝关节骨折经手术治疗的患者。然后按手术方法对受试者进行分层。然后比较骨科外科医生和足科医生的平均总辐射剂量(mRad)和平均总透视时间(秒)。在纳入的 333 例手术中,186 例由骨科医生完成,147 例由足病医生完成。使用多元线性回归分析控制年龄、性别、种族、民族和体重指数后发现,与足病医生相比,由骨科手术进行孤立踝关节ORIF并进行巩膜修补的患者的平均透视时间明显更短(68.4秒对104.8秒;P = 0.028)。此外,与足病治疗相比,由骨科手术进行的三极ORIF联合趾捻发音修补术的平均总辐射剂量明显更低(244.6 mRad对565.6 mRad;P = 0.009)。与足病医生的手术相比,由骨科医生实施的孤立踝关节和三踝关节骨折联合巩膜修复手术中,患者和手术团队受到的辐射明显更少。
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来源期刊
CiteScore
2.60
自引率
6.70%
发文量
282
审稿时长
8 weeks
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