Differences in Intraoperative Fluoroscopic Radiation Exposure during Ankle Fracture ORIF between Orthopaedic Surgery and Podiatry

Category: Ankle; Trauma Introduction/Purpose: Operative ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used, however, excessive radiation can be harmful to both the patient and surgical team. The primary aim of this study is to determine if there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. Methods: This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018 and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients greater than 18 years of age with an ankle fracture managed operatively were included. Subjects were then stratified by procedure. Mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Results: Of the 333 included procedures, 186 were performed by orthopaedic surgeons and 147 were performed by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared those performed by podiatry (68.4s versus 104.8.s; p = 0.0280). Additionally, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared to those performed by podiatry (244.6 mRad v 565.6 mRad; p = 0.0090). Conclusion: Patients and surgical teams are exposed to significantly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared to those performed by a podiatrist.