Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(24):10 Injury. 2023 01-Oct:. 10.1016/j.injury.2023.110962What this means for my practice?
The biplanar C-arm configuration exposes the surgeon’s neck to significantly less radiation and reduces fluoroscopy time compared with the inverted/uniplanar configuration, though at the cost of a longer operation. Clinically, this supports prioritizing biplanar positioning to minimize occupational radiation risk while maintaining procedural safety. Limitations include a small sample size, approximate wrist dosimetry, lack of patient radiation data, and each surgeon performing only two cases per technique.
Study Summary
Twenty children (mean age 6.7 years) with Gartland type III supracondylar humerus fractures were randomized to surgery using either a uniplanar (inverted) C-arm configuration or a biplanar configuration. Five senior surgeons each performed four cases, two using each configuration. Dosimeters were placed on the surgeon’s wrist (direct radiation), neck, and waist (scatter). The primary outcomes were radiation exposure at each site. Secondary outcomes included fluoroscopy exposure time and total operative time. Overall, the results of the study revealed that the uniplanar (inverted) configuration produced significantly longer fluoroscopy exposure times, whereas the biplanar configuration resulted in significantly longer operative durations. Waist and wrist radiation did not differ between groups. These findings indicate that surgeon radiation exposure—especially to the neck—can be reduced by using a biplanar configuration.
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