ABSTRACT
INTRODUCTION: Elastic stable intramedullary nailing (ESIN) is a well-defined and appropriate treatment of choice for long bone fractures. Despite its benefits, the risk of cancer from imaging devices is of particular concern for younger adults. So, this survey was conducted to estimate the doses administered to patients undergoing ESIN of long bone fractures utilizing a 2-dimensional (2D) C-arm fluoroscopy machine during surgery, as well as the carcinogenic risk associated with the use of the machine. METHODS: This study was conducted on 147 patients who required ESIN for long-bone fractures. Patients' demographic data, surgical data and imaging information were collected. For each patient, the organ doses and the effective doses were computed with the Monte Carlo PCXMC 2.0 simulation software. The cancer risk models proposed in the Biological Effects of Ionizing Radiation VII (BEIR VII) Phase 2 report were used to evaluate the risk of exposure-induced cancer death (REID) values. RESULTS: For all patients, the highest organ dose was delivered to the gonads. The mean effective dose was 0.026 ± 0.015 mSv and 1.3E-04 ± 1E-04 mSv for ESIN of femur and tibia fractures, respectively. Males had a mean REID of 1 per million, while females had a mean REID of 0.19 per million. The younger males had considerably higher REID values. The effective dose was significantly correlated with age, gender, and irradiation time. CONCLUSION: Low levels of effective doses and cancer risks associated with the utilization of the fluoroscopy machine in current practice were found in ESIN treatment of long-bone fractures. IMPLICATIONS FOR PRACTICE: This outcome will help to raise surgeons' awareness of radiation risks and encourage them to initiate measures to keep radiation dose and exposure time as low as reasonably achievable.
Subject(s)
Fracture Fixation, Intramedullary , Radiation Dosage , Radiation Exposure , Humans , Fluoroscopy , Male , Female , Fracture Fixation, Intramedullary/methods , Adult , Middle Aged , Risk Assessment , Aged , Tibial Fractures/surgery , Tibial Fractures/diagnostic imaging , Femoral Fractures/surgery , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Bone Nails , Neoplasms, Radiation-Induced/etiology , Monte Carlo Method , Young AdultABSTRACT
BACKGROUND: Reamed interlocking intramedullary nailing is considered the gold standard treatment for complex fractures of the femoral and tibial shaft. There has been some controversies about dynamization of statically locked nails, and some authors recommended routine dynamization for promotion of healing. This study aims to evaluate treatment of complex fractures in tibia and femur with static interlocking intramedullary nail method. METHODS: In a retrospective study from January 2003 to April 2008, 173 patients with femoral and tibial shaft fracture that were treated with this method were enrolled. No rod was dynamized in our patients. RESULTS: All patients with tibial fractures achieved union without any need for dynamization during 12-18 weeks (mean; 13.4 weeks). Four patients developed delayed union but all achieved union without any intervention. In femoral fracture, all but one patient achieved complete union during 10-30 weeks (mean: 18.3 weeks). One patient developed non-union who was treated by an exchange nailing and iliac bone graft method. No significant complication was observed in our patients. CONCLUSION: It is not necessary to routinely dynamize nails in tibial and femoral shaft fractures as all fractures united in acceptable alignment without any complication.
ABSTRACT
Unilateral or segmental pulmonary involvement in sarcoidosis is rare. So is unilateral lymphadenopathy, and the combination can cause considerable difficulty in diagnosis if it is present when the patient first attends. Sarcoidosis should be considered in the differential diagnosis of unilateral lung lesions.
