PF8 Expandable intramedullary nailing: a new method in the treatment of femoral periprosthetic fractures

Introduction: High doses of ionizing radiation are used during surgeries such as interlocking intra-medullary nailing and minimally invasive plate osteosynthesis. So, excessive use of fluoroscopy is seen to be a feared procedure among orthopedic surgeons. DAP (Dose area product) values which shows the total radiation dose with the aid of preinstalled DAPmeters, can bemonitored on the recent fluoroscopic units in mGy·cm2 or mGy·m2. This value is a more reliable indicator than the fluoroscopy time. The aim of the study is to investigate the total fluoroscopic DAP values in interlocking intramedullary nailing operations and comparing the total values with other radiologic procedures. Materials and Methods: Between 2010 and 2012, nine patients underwent femoral locking intramedullary nailing operation in our institute. Total DAP values, fluoroscopy time and number of images were retrieved from the fluoroscopic unit’s HDD. We have also recorded the DAP values of postoperative direct roentgenograms which were taken with portable digital x-ray machine which has on-board DAP meter. While the mean operation time was 3.2 hours (2–4.2 hours), total fluoroscopy use was 1.6 minutes (0.8–3.1 minutes). Results: Total mean DAP value was resulted in 1720mGy·cm2 and total number of fluoroscopic images were 44 (16–82). The mean DAP for postoperative AP and lateral direct femur radiographs were 1790mGy·cm2 and 2100mGy·cm2 respectively. We have found the total fluoroscopic unit DAP values comparable with even AP or lateral direct radiograms. Conclusion: DAP value is more practical than the fluoroscopy time in monitoring the total radiation dose used in the orthopedic procedures. If properly adjusted preoperatively, fluoroscopic units are more reliable and safe than the direct radiographies. We recommend routineuse of fluoroscopy insteadof direct radiographies intraoperatively.