Hyphenated-history: the Kocher-Langenbeck surgical approach.

The language spoken by orthopaedic surgeons is filled with eponyms. In orthopaedics, perhaps more than any other medical specialty, we speak cryptically to one another using code words and other secret language. Certain hyphenated eponyms are of particular interest because they pique one's curiosity as to how these people came to be partners in orthopaedic history. In this paper, we offer some bits of orthopaedic hyphenated-history, outlining the pertinent work of Theodor Kocher and Bernhard von Langenbeck, as well as associated background information. These two surgeons are linked through a common hyphenated eponym in orthopaedic surgery: the Kocher-Langenbeck surgical approach, a well-known posterior approach to the proximal femur and acetabulum.

Radiation exposure to the orthopaedic surgical team during fluoroscopy: "how far away is far enough?".

OBJECTIVES: To correlate the amount of radiation exposure to members of the orthopaedic surgical team based on their relative positions during a simulated fluoroscopically assisted orthopaedic procedure. DESIGN: Experimental study using commercially available fluoroscopic units and dosimetry badges designed to measure "eye" (ocular lens), "shallow" (hands/skin), and "deep" (whole-body) radiation exposure. SETTING: Standard hospital operating room at a level one trauma center. PARTICIPANTS: Dosimetry badge clusters at specified distances from a fluoroscopic x-ray beam. Represented positions were direct beam contact, surgeon (12 in/30.5 cm), first assistant (24 in/70 cm), scrub nurse (36 in/91.4 cm), and anesthesiologist (60 in/152.4 cm). INTERVENTION: Dosimetry badges were systematically exposed by a protocol intended to maximize radiation scatter. A maximum time for continuous fluoroscope use was set at ten minutes. MAIN OUTCOME MEASUREMENTS: Radiation exposure readings from dosimetry badges processed by a commercially available dosimetry service. RESULTS: Maximum readings are reported. Direct beam contact resulted in approximately 4000 mrem/minute (40 mSv/min) of radiation exposure. Deep exposure for the surgeon and first assistant was 20 mrem/min (0.2 mSv/min) and 6 mrem/min (0.06 mSv/min), respectively. Superficial exposure was 29 mrem/min (0.29 mSv/min) for the surgeon and 10 mrem/min (0.1 mSv/min) for the first assistant. Eye exposure was 10 mrem/min (0.1 mSv/min) for the surgeon and 6 mrem/min (0.06 mSv/min) for the first assistant. At the scrub nurse position, no deep or eye exposure was detected. One positive badge for shallow exposure was noted at the scrub nurse position, reflecting a 2 mrem/min (0.02 mSv/min) exposure rate. After ten minutes of continuous exposure, badges assigned to the anesthesiologist position never registered any positive readings. CONCLUSIONS: These results indicate that unprotected individuals working twenty-four inches (70 cm) or less from a fluoroscopic beam receive significant amounts of radiation, whereas those working thirty-six inches (91.4 cm) or greater from the beam receive an extremely low amount of radiation.