Reducing exposure to radiation is a concern to physicians and supporting staff. Little is known about the factors leading to increased exposure in intramedullary nailing of long bone fractures. This study examines antegrade and retrograde nailing of femur and tibia fractures. Factors that increased radiation exposure were obesity, severely comminuted fractures, nails inserted through the piriformis fossa, and insertion of more locking bolts in femoral nails. In addition, femoral nails required more radiation exposure than tibial nails.

Exposure to radiation is a concern to physicians. The purpose of this study was to determine factors associated with increased radiation exposure with intramedullary nailing of long bone fractures.

Femoral nailing through the piriformis fossa, highly comminuted fractures, insertion of more locking bolts (femur), and obesity are each associated with the higher radiation exposure.

Factors associated with increased radiation exposure are identified for tibial and femoral nailing.

Radiation exposure was higher for nailing of femur fractures (ninety-two seconds) compared to nailing of tibia fractures (sixty seconds). Exposure was greatest for insertion through the piriformis fossa (one hundred and twenty-one seconds) and least for retrograde insertion (seventy-four seconds) and intermediate for insertion through the trochanter (eighty-seven seconds). Obese patients (BMI > 30) had higher exposure times for both femoral (obese-one hundred and sixty seconds, non-obese-eighty-five seconds) and tibial nailing (obese-seventy-nine seconds, non-obese-fifty-five seconds). Only the most severely comminuted fracture patterns (Winquist IV) were associated with increased fluoroscopy time. Increasing number of interlocking bolts was associated with higher exposure for the femur but not the tibia.

One hundred and thirty-nine consecutive patients treated with intramedullary nailing for either a femoral shaft (OTA 32, n=71) or tibial shaft (OTA 42, n=68) fracture were prospectively evaluated in this IRB approved study. Radiation exposure (c-arm fluoroscopy time) was measured. Femur fractures were treated with either a retrograde nail (n=24), an antegrade nail inserted through the piriformis fossa (n=20), or an antegrade nail inserted through the tip of the greater trochanter (n=27).

Funding: Smith & Nephew