We analysed the functional and psychological outcomes in children and adolescents with complex tibial fractures treated with the Ilizarov method at our frame unit.

An observational study with prospective data collection and retrospective analysis of clinical data was undertaken. Patients younger than 18 years and an open physis were included. The Ilizarov method (combined with percutaneous screw fixation in physeal injuries) was applied and immediate weightbearing recommended.

Sixty four patients (50 male, 14 female) aged between 4 and 17 years were admitted to our Major Trauma Centre from 2013 until 2016 (25 tertiary referrals). Thirty one (48%) patients were involved in road traffic accidents, 12 (19%) sustained injuries in full contact sports. The average weight was 51 kg (range 16–105 kg). Twenty three open tibial fractures (14 Gustilo 3A and 9 Gustilo 3B) and 15 associated physeal injuries were treated among a cohort of closed tibial fractures with significant displacement (10 failed conservative treatment prior to frame treatment).

We report a 100% union rate with a median hospital stay of 4 days (range 2–19) and a median frame time of 105 days (range 62–205 days). Malunions (> 5 degrees in any plane) were not observed. Three patients required bone transport. At the time of submission, 70% of patients and their parents reported functional outcomes using the Paediatric Quality of Life Inventory (PedsQL) at minimum six months post frame. The PedsQLTM 4.0 Generic Core Scales are comprised of parallel child self-report and parent proxy-report formats. Children's physical average scores were 79 out of 100 and average psychosocial scores were 80 out of 100 and for parent average physical scores were 78 out of 100 and the same for parent average psychosocial scores. These results suggest high levels of quality of life on the PedsQL. The median visual analogue health score (0–100) was 81 out of 100 (71–100), median Lysholm knee scores 98 (range 49–100) and median Olerud & Molander ankle scores 75 (range 40 – 100).

Regardless of age, weight and soft tissue damage and complexity of fracture pattern, the Ilizarov method has shown to be safe and effective treating tibial fractures in the paediatric and adolescent population admitted to our Major Trauma Centre. Furthermore, patients reported high physical and psychosocial functioning following treatment.

Level of evidence: IV (case series)

Background: There is increasing concern regarding radiation exposure to surgeons’ using fluoroscopic guidance during orthopaedic procedures. However, there is currently a paucity of information regarding the level of radiation exposure to the foot and ankle surgeon during fluoroscopically assisted foot and ankle surgery.

Methods: We conducted a 12 month prospective study to measure radiation dose absorbed by the hands of a dedicated right handed foot and ankle surgeon. A thermo-luminescent dosimeter ring (TLD) was worn on little finger of each hand. Measurement of the cumulative radiation dose was recorded on a monthly basis.

Results: A total of 80 foot and ankle cases involving fluoroscopy were performed. The total screening time was 3028seconds (s) (mean screening time 37.4s). Screening time correlated positively with the number of procedures performed (r=0.92, p< 0.001), and with radiation dose in both the left TLD (r=0.85, p=0.0005) and right TLD (r=0.59, p=0.0419). There was no significant difference in radiation dose between either hand (p=0.62). The total radiation dose to the right TLD over the 12 months was 2.4 milli-sieverts.

Conclusion: Radiation dose incurred during orthopaedic foot and ankle procedures is proportional to the screening time. Our results show radiation exposure to be well below the annual dose limit set by the International Commission on Radiological Protection. This work demonstrates a simple and convenient method for evaluating a single surgeon’s radiation exposure.

Background: There is increased concern regarding radiation exposure to surgeons using fluoroscopic guidance throughout various procedures. However, relatively little information exists on the level of radiation exposure to the foot and ankle surgeon during fluoroscopically assisted foot and ankle surgery.

Methods: We are conducting an ongoing proespective study to measure radiation exposure to the hands of a single orthopaedic foot and ankle surgeon (RD). Over a 12-month period, thermoluminescent dosimeter rings are worn on the little finger of each hand of the operating surgeon. The rings are changed at six week intervals. Measurement of the overall radiation exposure is being recorded over this time period.

Results: This is an ongoing prospective study started in December 2004. We are measuring: total number foot and ankle cases using fluoroscopy, the total screening time for foot and ankle procedures, the mean screening time per procedure and the total radiation exposure to the thermoluminescent dosimetry rings.

Conclusion: Preliminary results show that radiation exposure is well below the current annual dose limit. In our study, radiation exposure during orthopaedic foot and ankle procedures is expected to comply with current recommendations of the European Committee on Radiation Protection and is well below dose limits set by the International Commission on Radiological Protection.