Rebecca Mills

BackgroundProximal femur fractures (PFFs) represent a major healthcare burden in the United Kingdom, with approximately 76,000 cases annually. Extra-capsular fractures are commonly treated with Dynamic Hip Screws (DHS), short or long intramedullary nails (IMNs), all of which require intraoperative fluoroscopy. Consequently, orthopaedic surgeons and patients are exposed to ionising radiation and the associated stochastic and deterministic risks. Despite regulations under the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R), a wide variation in radiation safety knowledge persists, and there are no established benchmarks for acceptable exposure. This audit aims to assess whether a departmental teaching programme could reduce radiation exposure during extra-capsular PFF fixation and to explore differences between consultant and trainee-led cases.MethodologyThis audit was conducted at Dorset County Hospital, United Kingdom, audit number 6323. Patients with closed extra-capsular PFFs managed using DHS, short or long IMN fixations were included. Radiation exposure, expressed as dose-area product (DAP), was recorded from the Picture Archiving and Communication System (PACS) across two audit cycles: before and after delivery of an educational programme, emphasising radiological stewardship and safety. Statistical analysis was performed using independent t-tests, with significance set at P < 0.05 and effect sizes reported using Cohen’s d.ResultsA total of 39 operations were analysed pre-intervention and 31 post-intervention. Overall mean radiation exposure decreased marginally from 347.4 to 344.6 cGycm² (P = 0.97, d = 0.01). Reductions were observed for DHS, from 245.6 to 210.8 cGycm² (P = 0.40, d = 0.27) and short IMN fixation, from 605.9 to 375.9 cGycm² (P = 0.18, d = 0.67). Long IMN fixation demonstrated a statistically significant increase in mean dose, from 246.8 to 764.5 cGy·cm² (P = 0.01, d = -2.56). Consultant-led cases showed a non-significant increase in mean radiation dose from 404.0 to 462.6 cGycm² (P = 0.75, d = -0.16). Cases led by other grades demonstrated a small, non-significant reduction from 332.8 to 303.6 cGycm² (P = 0.67, d = 0.12).DiscussionThe teaching programme was associated with modest improvements in radiation exposure for DHS and short IMN fixation, suggesting that structured education may enhance radiological stewardship. However, the increase observed in long IMN fixation likely reflects case complexity and limited sample size rather than a failure of the educational intervention. These results reinforce that educational measures alone are insufficient; lasting improvements require integration with simulation training, feedback on fluoroscopy use, and adherence to optimised imaging protocols.ConclusionsA single departmental teaching session produced non-significant reductions in radiation exposure for DHS and short IMN procedures, supporting the role of targeted education in improving radiological practice. The increase in exposure for long IMN fixation likely reflects procedural complexity rather than educational failure. This highlights the need for continuous training, technical optimisation and regular audit to ensure adherence to IR(ME)R principles. Larger multicentre studies with case-mix adjustment are warranted to establish national reference levels and to evaluate the sustained impact of educational interventions on radiation safety.

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