Archives of Orthopaedic and Trauma Surgery

, Volume 124, Issue 10, pp 659–664 | Cite as

Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study

  • Thomas R. Blattert
  • Ute A. Fill
  • Elmar Kunz
  • Werner Panzer
  • Arnulf Weckbach
  • Dieter F. Regulla
Original Article



The objective of this clinical trial was to determine whether there is a skill dependence for the total amount of radiation exposure to orthopaedic surgeons caused by fluoroscopy during intramedullary fracture fixation.

Materials and methods

Surgical teams were assigned to either the ‘Senior group’ or the ‘Junior group’ according to their professional qualification and clinical appointment. Twenty-two long-bone shaft fractures were stabilized with intramedullary nails. The radiation exposure was measured at different body locations including fingers, trunk and head by means of thermoluminescent LiF:Mg,Cu,P detectors. The total time of fluoroscopy was registered for each operation.


Mean time of fluoroscopy per operation was 4.43 min for the ‘Senior group’ and 6.95 min for the ‘Junior group’. The surgeons’ hands were exposed to markedly higher doses (range 0–2.88 mSv ‘Senior group’; 0–11.94 mSv ‘Junior group’) than their trunk and head (range 0–0.27 mSv ‘Senior group’; 0–0.38 mSv ‘Junior group’). After analysis of variance, differences between both groups proved to be statistically significant for all fingers measured (p≤0.02) and for the total time of fluoroscopy (p=0.019).


Generally, the hands are at higher risk than are the trunk and the head, and this finding is independent of surgical skills. However, an additional hazard is created for the less experienced surgeon by a highly varying and poorly predictable exposure of the hands and time needed for fluoroscopy. Thus, the use of radiation is more consistent and standardized with a skilled surgeon.


Radiation Fluoroscopy Thermoluminescent dosimetry Intramedullary fracture fixation Clinical competence 



We thank C. Ulrich for his practical assistance during the project. No financial support was received. The study complies with the current laws of the country in which it was performed.


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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Thomas R. Blattert
    • 1
  • Ute A. Fill
    • 2
  • Elmar Kunz
    • 3
  • Werner Panzer
    • 2
  • Arnulf Weckbach
    • 1
  • Dieter F. Regulla
    • 2
  1. 1.Trauma SurgeryWuerzburg University HospitalWuerzburgGermany
  2. 2.GSF—National Research Center for Environment and HealthInstitute of Radiation ProtectionNeuherbergGermany
  3. 3.District HospitalRastattGermany

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