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Carbon Footprint in Hand Surgery: Assessment of Single Use Material versus Conventional Set for Fixation of Distal Radius Fracture
Emmanuel H Masmejean, MD, PhD, Prof. and Sharon Abihssira, MD, Georges-Pompidou European Hospital, Paris, France

Introduction: Climate change is a growing threat to public health. As a paradox, healthcare produces greenhouse gases (GHGs) responsible for this. Carbon footprint (CF) estimates GHGs emissions but is underdeveloped in healthcare. To date, there is a lack of assessment in orthopedic surgery.
Distal radius fractures (DRF) is probably the most common surgical fractures. When surgery is required, volar plate fixation is often chosen. With the development of single-use set (SU), cost-saving and timesaving have been widely studied but there is no data about its ecological impact.
Our purpose is to assess the CF of SU and conventional sets for DRF, from their production to their use.
Materials and Methods: Life cycle assessment (LCA) of SU and conventional set, produced by the same French society, was performed. CF was measured for each set in a teaching university and a private hospital in Paris. GHGs emissions of production, distribution, and use have been calculated and converted into carbone dioxide equivalent (kgCO2).
Results: Production of a conventional set is 29 times more emissive than a SU set (735 kg CO2 Vs 26 kgCO2). For one case, use of a conventional set is 8 times more emissive than a SU set (10,1 Vs 1,3 kgCO2) and it doubles in the private hospital. The gap is reduced with repetitive use but remains in favor of SU set, even for 200 cases/year (26 Vs 41 kgCO2).
Scenarios of use in Germany and Australia show that the gap is raised up to 65 kgCO2 and 117 kgCO2 respectively, due to GHGs emissions in distribution and energy use during consumption.
Conclusion: CF of SU set is less important than conventional set in all scenarios. Orthopedic surgeons should be aware of those LCA results. Additional research is needed to estimate the resulting pollution.


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