Cumulative Annual Below-Apron Radiation Exposure Among Orthopedic Residents and Procedure-Specific Fluoroscopy Demand During PFNA Fixation of Intertrochanteric Femur Fractures

Aim: This study aims to evaluate the use of fluoroscopy during PFNA fixation and to assess the annual protected occupational radiation exposure of orthopedic residents using routinely collected dosimetry data. We also investigated whether fluoroscopy demand differs between AO/OTA 31A1 and 31A2 fracture types.Methods: In this retrospective single-center study, patients who underwent PFNA fixation for AO/OTA 31A1–31A2 intertrochanteric femur fractures between January 2024 and February 2025 were analyzed. Fluoroscopy counts, and operating residents’ dosimeter readings [Hp(10) and Hp(0.07)] were recorded. Univariable and multivariable analyses were used to assess factors associated with fluoroscopy use.Results: Fifty-seven patients (mean age 79.4 ± 11.0 years; 71.9% female) were included. The median fluoroscopy count was 140 (IQR 100–250). AO 31A2 fractures required more fluoroscopy than AO 31A1 fractures in univariable analysis (200 vs 120 shots; p = 0.01). However, no independent predictors of fluoroscopy use were identified in the multivariable analysis. Fluoroscopy count was not associated with age, sex, or surgeon-related factors. Mean annual radiation exposure was 1.83 mSv [Hp(10)] and 2.12 mSv [Hp(0.07)], both well below recommended occupational limits. These dosimetry values reflected cumulative below-apron exposure from all fluoroscopy-guided occupational activities and could not be attributed specifically to PFNA fixation.Conclusion: Although more complex fracture patterns were associated with increased fluoroscopy use in the univariable analysis, no independent determinants were identified after adjustment. Despite variability in fluoroscopy use, annual below-apron Hp(10) and Hp(0.07) values remained well below international dose limits, though they did not capture the full scope of occupational radiation exposure. No independent predictors of fluoroscopy use were identified in this study; however, weaker associations cannot be excluded given the limited sample size.