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Jones, D. G. and Stoddart, J. (1998)
ANZ Journal of Surgery, 68: 782–784.
There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received.
A 6–month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct–skin doses. Screening times were recorded in subsequent 6–month post at tertiary trauma centre.
Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon's hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17-0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one–third of recommended limits. If printer was used to record the image, 58% of intra–operative radiographs would have been avoided.
Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose-reduction gloves should be considered for high–risk procedures. A printer can reduce the need for intra-operative plain radiographs.
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Stoddart, J., Horne, G. and Devane, P. (2002)
ANZ Journal of Surgery, 72: 405–407.
A retrospective study of 138 patients with fractured hips was undertaken to determine if a delay to surgery beyond 24 h influenced 1-year mortality. In particular, the results of the subgroup of patients who were in the American Society of Anesthesiologists (ASA) Class 3 or 4 were considered.
Patients were found using ICD-9 database information. One-year mortality data was collected from Births, Deaths and Marriages − the New Zealand government agency that collects and stores statistics on these events.
The 1-year mortality rate was 17.4%. Age, operation type and time to surgery did not significantly affect 1-year mortality. American Society of Anesthesiologists’ Class 1 and 2 patients had a significantly lower 1-year mortality (5.3%) than ASA Class 3 and 4 patients (22.4%) (P = 0.02).
Time to surgery did not significantly affect 1-year mortality within each ASA Class.
Salil Pandit, Chris Frampton, Julian Stoddart and Tim Lynskey. (2011)
International Orthopaedics, Vol. 35, Num 12: 1799-1803
The aim of this study was to report normal values of the tibial tuberosity–trochlear groove distance (TTTG) in males and females and assess the reliability of MRI in measuring TTTG.
Patients presenting with a suspected meniscus injury without any patellofemoral or ligamentous instability, and arthroscopically normal cruciate ligaments and patellofemoral joints were included in the study. K-PACS© was used for MRI analysis and was performed by three observers blinded to each others’ measurements.
One hundred patients (57 males, 43 females) were recruited from 2006–2010. The mean TTTG in males was 9.91 mm (95% CI 8.9–10.8 mm) and in females 10.04 mm (95% CI 8.9–11.1). The coefficient of variation was <10% for both intra and inter-observer analysis.
The normal TTTG distance is 10 ± 1 mm with MRI being a reliable method of measurement. Literature supports a high degree of variability in reporting TTTG. This study establishes normal TTTG values, which will help in the assessment and treatment of patellofemoral disorders.
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