BRIEF REPORTS

A LEAD APRON FOR CLOSED FEMORAL NAILING

B. MAHAISAVARIYA, C. SUIBNUGARN, W. LAUPATTARAKASEM, W. KOWSUWON

Closed nailing, often considered the treatment of choice and the trochanter; this shields the patient’s perineum
for adult femoral fractures, normally requires the use of and the surgeon from radiation. It is effective when the
an image intensifier. This generates radiation which, in X-ray beam is emitted from below upward and the
a difficult case, may be excessive. Two areas particularly operative field includes parts of the gluteal and trochan-
vulnerable to radiation but usually lacking adequate teric areas (Fig. 1).
protection are the patient’s perineum and the surgeon’s Clinical study. Between March 1988 and January 1989,
head and neck (Miller et a! 1983). We describe a method 24 closed femora! nailings (without distal locking) were
ofreducing this hazard. performed. In 12 the method described was used, the
others acted as controls. Dosimeters (Dosimeter Corpo-
ration of America) were used to measure the radiation at
the patient’s perineum and the surgeon’s neck. The image
intensifier was set at 50 KV and 40 mA and the exposure
times recorded. Table I shows that there was no
significant difference in exposure time between the two
groups, but that the dose received at the target areas was
significantly reduced in the protected group.

Table I. Mean radiation doses (s.d.) exposed at target areas

(milli-Roentgen)

Surgeon’s Patient’s Exposure

Study group neck perineum time (mm)

Protected 1.75 (0.97) 5.00(1.21) 12.75 (2.01)

Fig. 1 Control 10. 1 2 (2.76) 15.83 (2.89) 1 1 .75 (2.27)

P-value <0.005 <0.005 >0.10

Method. The patient is placed in the lateral position on a

fracture table with the affected side uppermost. The
affected hip is flexed around a centre post with a T-piece Discussion. Although the amount of radiation to which
against the perineum. Traction is applied through a the surgeon, patient and operating room personnel are
closely-fitting boot connected to a windlass. The unin- exposed is, for a single case, relatively low with modern
jured side is kept out of the way on a special support. A image intensifiers, the cumulative dose with repeated
0.5 mm lead apron is then hung perpendicularly and exposure may be hazardous. The method described
beneath the affected thigh midway between the fracture provides effective protection and we strongly recommend
its use.

No benefits in any form have been received or will be received from a

B. Mahaisavariya, MD, Associate Professor commercial party related directly or indirectly to the subject of this
C. Suibnugarn, MD, Lecturer article.
W. Laupattarakasem, MD, FICS, FRCS(T), Associate Professor and
Deputy Chairman
W. Kowsuwon, MD, MSc, Assistant Professor
Faculty of Medicine, Khon Kaen University, Khon Kaen 40002,
Thailand. REFERENCE

Correspondence to Mr B. Mahaisavariya.
Miller ME, Davis ML, MacClean CR, et a!. Radiation exposure and
© 1990 British Editorial Society ofBone and Joint Surgery
associated risks to operating-room personnel during use of
030l-620X/90/SR79 $2.00
fluoroscopic guidance for selected orthopaedic surgical procedures.
J Bone Joint Surg [Br! 1990; 72-B :922.
J Bone Joint Surg [Am] 1983 ; 65-A :1-4.

922 THE JOURNAL OF BONE AND JOINT SURGERY