Intra operative radiation exposure increases when trainee orthopaedic surgeons are allowed to operate on ankle fractures

A. Kheiran, D. Makki, P. Banerjee, D. Ricketts, D.Fergusson

Introduction: Unstable ankle fractures are commonly treated with operative fixation. Isolated lateral malleolus fractures (Weber B) are often operated by orthopaedic trainees.Operative fixation of these fractures is included in the index procedures of procedure based assessment (PBA) of intercollegiate Surgical Curriculum Programme (ISCP). Orthopaedic trainees are expected to be competent in this procedure by the end of their training. Fluoroscopic guidance is essential for adequate reduction and safe fixation of these fractures.

Aims: It is currently unknown if patients are exposed to excess radiation when they are operated by trainees compared to consultant surgeons. It is a common perception that trainees take more time to fix these fractures compared to trained consultants thereby exposing patients to untoward effects of prolonged tourniquet time.

Method: A retrospective review of fifty patients undergoing operative fixation of Weber B lateral malleolus fractures were undertaken.Twenty five patients were operated by orthopaedic consultants and the remaining (n=25) by orthopaedic trainees.The tourniquet time and the intra-operative radiation dose using the fluoroscope were recorded.

Results: Patients operated by trainees were exposed to significantly higher dose of intra-operative radiation (median, 6.5Gy vs 46.2Gy; interquartile range,0.87-15.8 vs 8.37-140.3;P=0.003). However, there was no statistical difference in the duration of application of the tourniquet in between the two groups (median, 59 minutes vs79 minutes; interquartile range, 45-95 vs 69-102; P=0.12).

Discussion: This is the first study to indicate that patients are at risk of higher radiation exposure when operated by orthopaedic trainees whilst the times taken to fix Weber B ankle fractures are almost similar to those undergoing surgery by a consultant grade surgeon.