The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

Abstract

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient’s first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9–16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

Low‐value injury care in the adult orthopaedic trauma population: A systematic review

“…Most studies were based on case series ( n = 33) 22,31,33,34,36,38,41,43‐50,56,57,60‐64,66,68‐72,74,75,77,85,89,90 followed by systematic reviews with or without meta‐analysis ( n = 12), 23‐25,28,29,39,53,59,67,78,83,86,88,91 prospective cohorts ( n = 9), 30,32,35,37,42,51,54,79,87 RCTs ( n = 9) 27,55,65,73,80‐82,84 and retrospective cohorts ( n = 2; Supplemental Digital File ) 52,58 …”

Intraoperative Fluoroscopy Versus Postoperative Radiographs in Assessing Distal Radius Volar Plate Position: Reliability of the Soong Classification

“…For fracture reduction and fixation, the value of early postoperative radiographs in the treatment of distal radius fracture fixation has been questioned, and some studies have demonstrated that these images do not change postoperative management. 20 , 21 , 22 Sharma et al 21 found that among 172 patients with early postoperative radiographs following distal radius fracture fixation, only 7 patients had alterations in their postoperative management with only 1 patient requiring immediate surgical revision as indicated by imaging.…”

Low value Injury Care in the Adult Orthopaedic Trauma Population: A Systematic Review

“…Most studies were based on case series (n=33) 22,31,33,34,36,38,41,[43][44][45][46][47][48][49][50]56,57,[60][61][62][63][64]66,[68][69][70][71][72]74,75,7785,89,90 followed by systematic reviews with or without meta-analysis (n=12) [23][24][25]28,29,39,53,59,67,78,83,86,88,91 , prospective cohorts (n=9) 30,32,35,37,42,…”

“…78,83 , two RCTs 82,84 , three cohort studies (one prospective) 42,52,58 and 32 case series31,33,34,36,41,[43][44][45][46][47][48][49][50]56,57,[60][61][62][63][64]66,[68][69][70][71][72][74][75][76][77]85,89,90 evaluating routine post-treatment imaging and follow-up consultations.…”