Comparison of radiation exposure between pulsed and continuous fluoroscopy during PFN-A fixation of pertrochanteric fractures

Aims: Fluoroscopy is widely used in orthopedic surgery but raises concerns regarding radiation exposure. This study aimed to compare radiation exposure between pulsed and continuous fluoroscopy modes during PFN-A (proximal femoral nail - antirotation) fixation of pertrochanteric femoral fractures.Methods: In this retrospective cohort study, 102 patients treated with PFN-A for AO/OTA (Arbeitsgemeinschaft für osteosynthesefragen Foundation/Orthopedic Trauma Association) type 31A1.2 and 31A1.3 pertrochanteric fractures at a single institution between January 2024 and January 2025 were included.Results: No significant differences were observed between groups in terms of fluoroscopy time, total radiation dose, DAP (dose-area product), or number of exposures. However, radiation exposure per image was significantly lower in the pulsed fluoroscopy group, as demonstrated by both dose per image (p = 0.001, r = 0.32) and DAP per image (p = 0.002, r = 0.29). In adjusted analyses, fluoroscopy mode remained a significant predictor of radiation exposure per image (F = 9.07, p = 0.003). Image quality was considered subjectively adequate based on intraoperative assessment, with no clinically relevant difference between the groups. Radiation exposure was also normalized per image. Statistical analyses were performed using the Mann–Whitney U test and ANCOVA.Conclusion: Pulsed fluoroscopy does not significantly reduce total radiation parameters but is associated with lower radiation exposure per image during PFN-A fixation of pertrochanteric fractures. These findings indicate a reduction in radiation exposure per image without significant differences in total radiation parameters.