Factors influencing radiation exposure time and methods to reduce it: Analysis of volar locking plate fixation of distal radius fractures.

Abstract

Volar plate fixation under C-arm fluoroscopy is common in treating distal radius fractures in adults. Limiting live fluoroscopy is recommended as a theoretically simple and effective way of reducing radiation exposure by lowering the dose area product; however, real-world data are absent. This study aims to show which factor influences radiation exposure time and whether it is safe to abandon cine sequences in volar locking plate fixation procedures. This was a retrospective case-control study of distal radius fractures fixed with volar locking plates from 2018 to 2022. During the first period, six orthopaedic surgeons performed the surgery with their preferred fluoroscopy methods. During the second period, the single-shot technique was instructed, where surgeons avoided dynamic video imaging under fluoroscopy. Data collected include fluoroscopy time, operative time, fracture classification according to Association of Osteosynthesis (AO) criteria, post-operative radiographic changes of the radius, and patient demographic information. During the first period, 59 cases were included in the study. Radiation exposure time did not correlate with time elapsed from fracture to surgery, AO fracture classification or post-operative radiographic changes. Operative time and patients' body mass index showed a weak positive correlation with radiation exposure time. Significantly differing radiation exposure times were observed among surgeons. The surgeon with the shortest exposure time employed the single-shot technique. On the other hand, the surgeon with the longest exposure time continuously pressed the pedal. During the second period, 63 cases were included in the study and irradiation time decreased from a median of 159 seconds to 19.5 seconds. Three cases required implant removal due to complications in each period. Behaviours and attitudes toward fluoroscopy vary among surgeons. The single-shot technique reduced the radiation exposure time during volar locking plate implantation without an associated increase in plate removal to manage a complication.