Intraoperative radiation exposure in elastic stable intramedullary nailing (ESIN) during the growth period. Observations in 162 long bone shaft fractures

BACKGROUND: The increase of intraoperative radiation exposure in intramedullary techniques of osteosynthesis is recognised and accepted in adults especially in interlocked nailing. In contrast data about fluoroscopy times in elastic stable intramedullary nailing (ESIN) in children and adolescents are hardly available. MATERIAL AND METHOD: Operation records of 162 surgical procedures (8.6% humerus, 43.8% forearm, 32.7% femur, 14.8% lower leg) of a 3-year period were evaluated retrospectively. The mean age was 6.1 years in femoral shaft fractures, nearly similar in forearm and lower leg fractures (8.7 and 7.9 years, respectively) and 12.4 years in patients with humeral shaft fractures. RESULTS: Mean operation (OP) and fluoroscopy times (FL) were increased in humeral fractures (58.1 min OP, 1.62 min FL), at a medium level in forearm fractures (35.2 min OP, 1.06 min FL) and femoral fractures (42.3 min OP, 1.27 min FL) and shortest in lower leg fractures (29.6 min OP, 0.69 min FL). CONCLUSION: Our results and literature analysis show that optimal technical conditions, especially the use of a pulsed image intensifier and well-trained theatre staff, are able to reduce intraoperative radiation load.