Utilization of an Intraoperative Real-Time Radiograph Counter on Radiation Exposure Events for Distal Radius Fracture Fixation: A Follow-Up Investigation.

Abstract

Purpose: Reducing fluoroscopic utilization in the operating room may aid in mitigating some radiation-related health consequences. The Hawthorne effect suggests that surgeons change their behavior during periods of observation. The purpose of this investigation was to evaluate changes in radiation emission with the use of a real-time, intraoperative radiograph counter during open reduction internal fixation of distal radius fractures.

Methods: We reviewed a consecutive series of isolated open reduction and internal fixation of distal radius fractures within a single health care system. Three groups were created for comparison: a preintervention group without a radiograph counter, an intervention group with a counter, and a postintervention group where the counter was again removed. Baseline demographics and surgical characteristics were recorded. Reduction quality and radiation parameters were compared between the groups, which included radiation exposure events, fluoroscopy exposure times, and total radiation doses.

Results: A total of 430 cases were performed by nine surgeons: 160 preintervention, 135 intervention, and 135 postintervention. The final radial inclination and volar tilt were similar between the groups. Statistically significant differences were noted between the groups with respect to radiation exposure events, exposure times, and total radiation doses (P < .05). For each of these variables, radiation emission was the highest in the preintervention group and decreased significantly in the intervention group. Although all emission/exposure variables subsequently increased in the postintervention group, these increases were not statistically significant.

Conclusions: An intraoperative radiograph counter is associated with reduced fluoroscopic utilization during open reduction and internal fixation of distal radius fracture without reducing reduction quality. After the removal of the counter, nonsignificant increases were noted in all radiation parameters in the postintervention group, suggesting that the Hawthorne effect may be responsible for some of the reduced parameters in the intervention group.

Clinical relevance: In addition to education and protective equipment, consistent use of an intraoperative radiograph counter may aid in improving occupational safety for upper-extremity surgeons.