Radiation scattering to the primary surgeon during closed locked femoral nailing.

A prospective study of the radiation exposure to the primary surgeon during closed static locked femoral nailing was performed in 50 cases. There were 44 males and 6 females whose ages ranged from 15 to 70 years (average, 32). The degree of fracture comminution was classified by Winquist. The cases included 1 Winquist (WQ)1, 9 WQ2, 27 WQ3 and 13 WQ4. The Grosse-Kempf femoral nail was used in 40 cases and the AO interlocking femoral nail was used in 10 cases. The C-arm image intensifier model Phillip BV212 and BV 300 were used during the present study. The average operation time was 52 minutes (range, 30 to 120). The fluoroscopic time for the entire procedure average 132 seconds (range, 23 to 366). The radiation exposure to the primary surgeon ranged from 2 to 231 micro-Sv with an average of 30 micro-Sv per procedure. From the present study, it was found that radiation scattered to the primary surgeon during current practice for closed static femoral nailing using the recent model of C-arm image intensifier was minimal and far below the permissible dose. It was also found that the group using the C-arm model BV 300 (n = 16) had significant lesser fluoroscopic time and less radiation scattering to the primary surgeon than the group with model BV 212 (n = 34).

A comparison of MR myelography of brachial plexus injury with CT myelography and conventional myelography.

The purpose of study is to assess the accuracy of magnetic resonance myelography (MRM) of the cervical spine in patients with preganglionic Brachial Plexus Injury (BPI) by using CT myelography as the gold standard and comparing this with routine conventional myelography. Patients with a clinically diagnosis of Brachial plexus Injury were studied (9 males, 1 female, aged 16 - 42 years old) [mean age = 25.4 years old]). All patients had undergone clinical evaluation by an orthopedic surgeon and five patients had had additional somatosensory evoked potentials (SEP) performed. All patients were investigated by conventional myelography, computed tomography myelography (CTM) and magnetic resonance myelography (MRM). We used CT myelography as the gold standard and the accuracy of MRM and myelography were assessed in relative to this. The sensitivity in detecting a pseudomeningocele by MRM is 100% and the sensitivity in detecting nerve root abnormality is 90% at the level of the C5, C6 roots and 100% for the C7, C8, T1 roots. MR Myelography had many advantages over conventional and CT myelography which include the absence of radiation and the lack of need for intrathecal injection of contrast medium.

Musculoskeletal injuries from motorcycle accident the result of treatment at Siriraj Hospital.

A total number of 420 patients, the victims of motorcycle injuries were treated at Siriraj Hospital during a one year period (1983) were studied. Eighty six percent were male. The age of the patients less than 30 years old was 66 percent. Sixty six percent were drivers and nineteen percent were passengers. Injuries to the lower extremities were found in 60 percent ant the most common site was around the knee, lower femur and upper tibia. Spinal injuries were found on 20 patients, five of whom were found to develop neurological deficit. Early and accurate approach of management should be accomplished among the multiple limbs injured cases in order to facilitate easy nursing care, found care and avoid serious complications.